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Wisconsin Department of Commerce SOIL AND SITE EVALUATION
<br /> Divisionof 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 8 1/2 x 11 inches in size. Plan must County ......ff
<br /> include,but not limited to: vertical and horizontal reference point(BM),direction and g u r'U e-
<br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel l.D.#
<br /> APPLICANT INFORMATION- Please print all information. Reviewed,by ����'D( Date
<br /> P� you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). fi.- I - '4 s//7
<br /> P
<br /> y Owner
<br /> rty
<br /> ocation
<br /> .Q/4� 4-/OC P-P30� Govt. / 1/4 1/4,S'5/ T yD ,N,R /5 E(ore
<br /> Ply Owner's Marling Address Lot# Block# Subd.Name or CSM#
<br /> /6 70 s7— Rd vg' 2 t y /0-D a
<br /> City State Zip Code Phone Number 0 City
<br /> P/'��e tic 1 ref 1 g V/8'371( L'3a,'�-9-2.> ❑ Village Town Nea Road�-4-c.Ks v.`! 1 A4
<br /> J New Construction Use: cal Residential/Number of bedrooms og- Addition to existing building
<br /> ❑ Replacement ❑Public or commercial-Describe:
<br /> Code derived daily Itoowc,O D gpd Recommended design loading rate ,7 bed,gpdnt2 •$ trench,gpd/ft2
<br /> Absorption area required Vel c/ bed,ft2 03 75 drench,ft
<br /> 2 Maximum design loading rate ,7 bed,gpd/ft2 '8 trench,gpdift2
<br /> Recommended infiltration surface elevation(s) /6--- 7 ft(as referred to site plan benchmark)
<br /> Additional design/site considerations
<br /> Parent material GJAQ, L. n�c/pie¢- Flood plain elevation,if applicable /U ft
<br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
<br /> as CI= unsuitable for systemD Ih,S ❑ u 114 s ❑ u as El u .8s El u ❑s g,u
<br /> SOIL DESCRIPTION REPORT
<br /> Boring# Horizon Depth Dominant Color Mottles
<br /> Texture Structure Consistence Boundary Roots GPD/ft2
<br /> in. Mansell au.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench
<br /> ii . / 04 7-_7�f' �, /5
<br /> , //A1tr"e)4. cs 'Fa, ,� ; ,g
<br /> yea �,�y�� , — /s z dt rn5- 5$ 0, '7 1 egGround 3o sr, �-i -_, s a cy n 1 gS ', -.5''
<br /> elev.
<br /> 9ff!ft. y 87r 7 5YX rtr c.,457D f15 /,Tx* /n6)6" .
<br /> Depth to - ,
<br /> limiting ;
<br /> factor •
<br /> 6go,in.
<br /> Remarks:
<br /> Boring#
<br /> aQ I d-5-. 7/57/P
<br /> .5- /, ci- /ilrc/, ,gs rg#tco -1 j'
<br /> a,. 3 /9-to 7r s7,-� .-- p S� S c"S3. , /,,/ �/_5- A-C a - 7 :-f/
<br /> Ground r 6)-6a 7.Sy4 ram" .0 c157l l fL ifi,�ik /ruin'/'
<br /> elev. o--- ..r
<br /> 77',/ft - ittc,,,,j- _s7„.. '94.
<br /> Depth to
<br /> limiting _ ; G'I y
<br /> f r a6 in. Remarks:
<br /> CST Name (Please Print) Si natur phone
<br /> Tale No.
<br /> %-�e 4 '/ -Aa/27 G<,1' ./ry/5-.67 -, ,yy7-2 72C
<br /> Date CST Number
<br /> ieQer _Sf =sii' syY2 70-7.-7'a .75-,-7
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