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"nsconsin Department of Commerce SOIL AND SITE EVALUATION_of <br /> Division of,S�afety and Buildings <br /> Bureau of integrated Seftes in accordance with s. ILHR 83.09,Wis.Adm.Code <br /> Attach complete site pian on paper not less then 81/2 x 11 intcltes in size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and u 9—, <br /> percent slope,scale or dimensions,rwrlh arrow,and location and distance to nearest mad. Parcel I.D.# <br /> a o0 0 <br /> APPLICANT INFORMATION-Please print all info mation. Reviewed by DNg <br /> Personal information You pnowe may be used for secondary rw (P�y Law.s.15.04(1)(m)). fz <br /> Property Owner <br /> L / Property Location <br /> C/ c/ <br /> t cook GovL Lot 1/4 114.S3$1 T3 d/ .N,R 16 E(or)( <br /> Property Owners Mailing Address Lot# Bioclt# Subd.Name or CSM# <br /> 13 >e 3 951 !`i' sl- #JJ Tm©vud 6,eoK , <br /> City t State Zip Code Phone Number ❑ city ❑ wage ® Town Nearest Road <br /> S,renJ W-r 5147 c X66 s/a3 ee.�o.J L e leo r/v �r• <br /> E.New Construction Use: Wesidential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or cornmerdal-Describe: <br /> Code derived daily flow^30 o gpd Recommended design loading rate wed,9W? ro trench,gldfil? <br /> Absorption area required bed,ft2 �00 trench,ft2 Maximum design loading rate -S bed,gpolllz -—L —Wench,gW12 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional designtsits considerations 9'5. 9 <br /> Parent material e�f,4 c,�;�� C74^/T 7e- Flood plain elevation,if applicable got/.41- ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure I AT-Grade System in FII Holding Tank <br /> U = unsuitable for system Jos ❑ u cas ❑ U KS ❑ U %S ❑ u ECS ❑ U ❑S 19 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 /> 13 o--s 1-5 /his f <br /> Ground <br /> 9ft <br /> Depth to <br /> limiting <br /> factor <br /> '>Zlo,�Jn. <br /> Remarks: <br /> Boring# 24w S ; <br /> 13 ;2 '5 : <br /> Ground <br /> elev. <br /> 9�+L <br /> Depth to <br /> limiting <br /> factor <br /> 9�in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address r Date CST Number <br /> 4o X 5?-o7-5-- <br />