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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safoty 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 <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and "Leu le- <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> d/�- ���/ - off- 710 <br /> APPLICANT INFORMATION- Please print all information. Reviewed b n Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). C" Y ��(/1q <br /> Property Owner Property Location <br /> Govt.Lot 7 1/4 1/4,S T ,/ <br /> Property Owner's Mailing Address Lot# Block# 9abd Name or CSM# <br /> ,295-9f` 7 <br /> City / State Zip Code Phone Number ❑ City ❑ Village Town Neares�Roa��� <br /> �e Te l-� ( )0 <br /> 0a <br /> S C a <br /> M-New Construction Use: D41esidential/Number of bedrooms 1-7Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow -�0 gpd Recommended design loading rate i 7 bed,gpd/ft2 Z�trench,gpd/ft2 <br /> Absorption area required Z c/3 bed,ft' sqq3 trench,ft2/ Maxi mpdeysign loading rate��bed,gpd/fl2-z-5trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) !bi IfGD/9c��,P / / ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material r <br /> 1�S��}- � � � f" Flood plain elevation,if applicable <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S ❑ U RS ❑ US ❑ U S ❑ U S ❑ U ❑ S K-U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz. I Consistence Boundary Roots <br /> Bed Trench <br /> K <br /> IN <br /> ...:- � <br /> Ground O� is v dS <br /> elev. <br /> Y A <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring 0-7 <br /> # <br /> 7-,2 3f-c <br /> 7, 0 59 <br /> Ground <br /> celev. <br /> Depth to rr� <br /> limiting 10 <br /> factor ELI <br /> ` �in. Remarks: <br /> CST Name (Please Print) / Signature <br /> Telephone No. ry <br /> �'GY C ���l® ��Ci o�I l '—/2 LS <br /> Address Date CST Number <br />