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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Divisiort of Safety hind Buildings Page_L of,'�_ <br /> Bureau of Integrated Services in accordance with s. ILHR 83.09,Wis. Adm. Code <br /> Attach 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 �{ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> o zoz-93/ <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)). <br /> Property Owner Property Location <br /> J•o Govt.Lot 9 1/4 1/4,S I I T 40 ,N,R I+ Sofa)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> E 161-340 Lc)Aw<�r. <br /> City State Zip Code Phone Number ❑ City ❑ Village [a Town Nearest Road <br /> CRR5e r\ <br /> (�New Construction Use: 9 Residential/Number of bedrooms 1 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow1�5 _gpd Recommended design loading rate bed,gpd/itZ i•� trench,gpd/ft2 <br /> Absorption area required__014-'bed,ft2, 1?4i trench,ft 2 Maximum dessiigrl joaading rate i.z bed,gpd/ft2 L- trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) to/ Se r"70!�af 3.r29'fj6�o✓, F�C�iQ(ttixas referred to site plan benchmark) q <br /> Additional design/site considerations A awn Flexr IoC.O�/gA�E�-t"•{�win..t4p^-.l/�"p (030%nRrL w- �..f�4—Ljk7. 'e <br /> 11 1 <br /> Parent material t I AGRI. A4 V A Flood plain elevation,if applicable G_ ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-GradeSystem in Fill Holding Tank <br /> U = Unsuitable for system El Of U 15 s ❑ u ❑S 01 u El u Els 0 u Els e u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench <br /> 1 '{" �f-SYR z iY10 we .nabK irrfi^ C30J It �v <br /> Z 4-27 7.5Yk`fl�{ �te,.e 1rias IDK rnJT✓ c4) m ••7 <br /> A <br /> elev.Ground T- 9.'11'1 tl�SYR Q,a7" en5 14 FAl a Cod M �•7� .g <br /> 9��ft. •3B TSYRAr <br /> g1 251 IM/►. .►asbK rye i 5- !o <br /> Depth to <br /> limiting <br /> factor <br /> 287in. IJD CT.ft)• <br /> 91.15- Remarks: �: �� -1' 4.1"S' APv& "*;A Z-A F'oitcYoR <br /> Boring# <br /> 3" T.5Y(0/7_ aA 7^gb K M ed WRS .a • b <br /> 2, 75YRy t%SbK AWV r .1 -T 8 <br /> A �. R414 Rsl a " ,rsbrc .�+d�r C <br /> Ground R_4 16 It-2i9 `K-,fu -W r145 bK rri.Fr fi' AP S ,.(o <br /> elev. , <br /> Depth to <br /> limiting <br /> .ZS r ita <br /> n 1 Remarks: o <br /> CST Name (Please Print) Signature Telephone No. <br /> SEPTIC & EXCAVATION <br /> Address sir. Date CST Number <br /> 41/s/ <br />