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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division cif Safety and Buildings Page 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 81/2 x 11 inches in size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction andI <br /> c e�# <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. I.DD4 <br /> arcel .# <br /> O <br /> APPLICANT INFORMATION - Please print all information. Reviewed Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). - 8-/I- <br /> Property Owner Property Location [[[Govt.Lot 1/4 1/4,S T N,R� /K <br /> E or W <br /> Property Ownees Mailing Address Lot# Block# Subd.Name-er66M# <br /> GiAL I e -S ej � �T e c:.,4 Alao�l <br /> City State Zip Code Phone Number ❑ Ci Nearest Road <br /> {er � ) City ❑ Village Town <br /> ❑ New Construction Use: F15Aesidential/Number of bedrooms - Addition to existing building <br /> �fffleplacement ❑Public or commercial-Describe: -- <br /> Code derived daily flow �G gpd Recommended design loading rate gybed,gpd/ft2__z__Ztrench,gpd/ft2 <br /> Absorption area required '6Y3 bed,ft2 - .trench,ft Maximum design loading rate ' 7 bed,gpd/ft2 .F trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/site considerations`` -/ y <br /> Parent material C'/i4C i!� �1 �/�� Flood plain elevation,if applicable /I✓ ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding rTraandnk <br /> U = Unsuitable for system � EJr <br /> S U � Els El U P9U U Y9.S U s t[�.0 <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> 9 Texture Consistence Boundary Roots <br /> in. Munsell Du.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> 3 ; <br /> S 'e <br /> Ground o/ �,�t� 7!1 <br /> elev. <br /> ?MWft. <br /> Depth to <br /> limiting <br /> factor <br /> >?D in. <br /> Remarks: <br /> Boring# <br /> /5 <br /> 7'5je <br /> Ground <br /> elev. <br /> . ten <br /> Depth to <br /> limiting <br /> factor <br /> 7°min. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Addres Date CST Number <br />