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Wisconsin bepartment of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page I of <br /> Bureau of Integrated Services in accordance with s. ILHR 83.09,Wis. Adm. Code <br /> Attabh complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and v2N 6 TT <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Date �y <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> JAM F$ GN 1 L 17 5 Govt.Lot I 54/1/4 Nr.,)I/4,S /9 T 40,N,R /,� *(or)W <br /> Property Owner's Mailing Address Lot# Block# I SebdrNema or CSM# <br /> -;:'8 3 83 DAE/AJ Ro kD 2,2 V01- 5 �y 309 <br /> City State Zip Code Phone Number ❑ city ❑ Village 2rTown of Nearest Road <br /> (� 5rCr2 I W1 1 54 93 ( 7/5 ScaTr 171}61A) <br /> ,❑]New Construction Use: Residential/Number of bedrooms z Addition to existing building <br /> DJ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow &(20 gpd Recommended design loading rate bed,gpd/ft2 • 8 trench,gpd/ft2 <br /> Absorption area required 4Q9 bed,ft2_3_Z5__trench,ft2 Maximum design loading rate bed,gpd/ft2 •8 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 8 (tibl� EL&/AT/vN is CnrTK�cm(as referred to site plan benchmark) <br /> Additional design/site considerations LoNC, AhVWA%0 Dcs/b.v kersuAaq T mderr S61-64cxs Qom uczL i LMSE 660 <br /> Parent material G/.A<GI,?L- D r--r Flood plain elevation,if applicable It <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System In Fill Holding Tank <br /> U = Unsuitable for system p's ❑ u ❑s G3'u ZS ❑ u [Ers ❑ u ❑S ©'U ❑S au <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> 9 Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench <br /> 1 A o-4 7,5 y,2 -3/2- rr �S 055'-IFS YnVlrtr C 3F . 7 <br /> 7,5 .S <br /> d-18 '2 y/� ,s L 5 1 c 56.E rv%V f C 5 .r1 . .� <br /> Ground 6C- L17-0 <br /> 75 8k- V16 ,r S 0513 YA V F✓ CL-5 C h" .-7 g <br /> elev. <br /> �1/• ft. Gr7.582 8(14F.ifl 5 -514qYAV FV �s IK, nIP 'IJP. <br /> Depth to 7582 414 Nrtt 059 MV r-r — i wmLNPJ ;At <br /> limiting (Gy�✓ <br /> factor <br /> $in. <br /> Remarks: 6002" ARE Ta 6AjnTE2 C56As"VAL /1/6H wdrER I <br /> Boring# A o-4 7.5 /t -y 45 1 F Fr C S 3F 18 <br /> 3� <br /> bCL 7. A 5�/(0 ' r 0.S 161 '8 <br /> Ground 6Z-71 7.5 IX 4//4 F2 D 5 Y2 519 5 05 5 VFr C-S /01 Nq ;N <br /> elev. <br /> RL•2ft. <br /> Depth to <br /> limiting <br /> factor <br /> !05in. Remarks: Roors T WAr62- 9s SZ /VOTE. oR2uv6-5 00562UC-4 2R1 97 <br /> CST Name (Please Print i re Telephone No. <br /> I G C�onl t2� S 259 329 T <br /> Addresse Date CST Number C 70 r31 <br /> 28350 t�oNrJ>✓2 LAKi5 4AP ar&5r6W U11 !91993 tifh>< 9 Mo 3175 <br />