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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Pivision of Safety and Buildings Page_of <br /> Byreau 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. Fwarcel I.D.# <br /> o3z .53 <br /> 34 Oz= 400 <br /> APPLICANT INFORMATION - Please print all information. Reviewed by ' Date '� Li� <br /> Persdnal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). N�0 (( <br /> Property Owner Property Location I <br /> R UC t Govt.Lot 1/4 1/4,S ?;6.T41, ,N,R t� E(or( <br /> Subd.Name or CSM# <br /> Pro erty Owner's Mailing Addrgss Lot# Block# <br /> 1338 330 '' A,I- . 327.4439 .SS A15-9155 <br /> City State Zip Code Phone Number WMA ❑ City ❑ Village Town Nearest Road <br /> RevigizIc i W1 54.537 (715 )X7-$717 SLJrss M1N9_e1/A C)ACL..E <br /> ❑ New Construction Use: %Residential/Number of bedrooms 3 Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 5D gpd Recommended design loading rate '7 bed,gpd/ft2—'s—trench,gpd/ft2 <br /> Absorption area required IP43 bed,ft2 an*3 trench,ft2 Maximum design loading rate bed,gpd/W2�trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) J'7- ft(as referred to site plan benchmark) <br /> Additional design/site considerations F!{OP, 25 <br /> Parent material CLaej,4L VAI F ' Flood plain elevation,if applicable NA ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system Xs ❑ U ®s ❑ u ® s ❑ U M S ❑ U P s ❑ u ❑S MU <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure GPD/fl2 <br /> Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench <br /> 1 0.5p 7- K2 <br /> � -27 7. ar 4 4 •�-- M 5 <br /> Ground ?J •a� 7 I� 4 14 —' S .7 <br /> lev <br /> ltb.$ft 4 <br /> 6PM 7 ,r 416 >z s <br /> Depth to <br /> limiting <br /> f t , <br /> in. <br /> Remarks: YAA42 Au4191Z ftIE104 <br /> Boring# <br /> t 7- R fes_ NS <br /> �2 <br /> Ground <br /> elev <br /> X02 6ft. <br /> Depth to <br /> limiting <br /> fslctor <br /> 7 in. Remarks: AtJlb AuQW AotZ1" <br /> CST Name (Please Print) Signature Telephone No. <br /> L /10_&1A <br /> Addreis Date CST Number <br /> a w 3SsTE 3 G•?�-q8 z2S�S i <br />