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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> ' Division of Safety and Buildings Page of <br /> Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code <br /> i <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 uR/YCJ 1 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 020 431Z of 00 <br /> APPLICANT INFORMATION - Please print all information. Reviewed by ate <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). �l� _ I /0 /3-19 <br /> Property Owner `^ ' C Property Location Apr+„ <br /> RT Mil.}44:LJ Gnvt i nt sto 1/4 /0/4,S12_ T40 ,N,R 1( E(o6 <br /> Prope Owner's Mailing Address Lot# Block# <br /> Subd.Name or CSM# <br /> 1 Zq M igt1Otl li- )2.D . AcQEs <br /> State Zip Code Phone Number ElCity ❑ Village X Town Nearest Road <br /> CiV£r33TER• I \t 1545131 (115 )5W455( OAKLAID 114f/d,V8 /I,k. Rio. <br /> kNew Construction Use: Residential/Number of bedrooms 3 Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate • 7 bed,gpd/ft2 •g trench,gpd/ft2 <br /> Absorption area required 43 bed,ft2 5(73 trench,ft2 Maximum design loading rate •7 bed,gpd/ft2 • $ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 6. Z- ft(as referred to site plan benchmark) <br /> Additional design/site considerations /0°X S!vp <br /> Parent material fa j,.:}CJ'X}f_ PRIM" Flood plain elevation,if applicable NM ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system r S ❑ U I S ❑ U i S S ❑ U Ns O U '® S ❑ U ❑ S R`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 /> I I 0-5 75y,g/z .----- Ni iil �y 160 .7 S <br /> S-7r 7 /t 6 ----- ifrs 0 In .1 • S <br /> Ground <br /> qmft. <br /> Depth to <br /> limiting <br /> fa for ' <br /> 7 l in. <br /> ((( Remarks: <br /> Boring # t 0-.5 -j•SiK Z f�1 la of (9s l co .1 .a <br /> 2 �. 5-$3 7.g jiz ih. a— — its ;-- ml a .- .$ <br /> Ground 4 cr 9//_O <br /> `�i_sft. <br /> (Depth to <br /> limiting <br /> f t r <br /> f in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> �c i-1O R 0 110P14)1.15 )2''' -,� �- -- `]15- $fib- 415� <br /> Addre>fs Date CST Number <br /> ��-loo IJwy 35 -> �,wl . 9-$q3 ,fi-cl-qS 225 -► <br />