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WJsoonsin Department of Commerce SOIL AND SITE EVALUATION <br /> Djvision of 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 <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and LAQn( <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> APPLICANT INFORMATION - Please print all information. Reviewed by Date (� <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s:15.04(1)(m)). r i/ <br /> Property Owner Property Location n <br /> Q Govt.Lot '5Q 1/4 �W1/4,S 2g T3* ,N,R b E(o <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 50 EgEEPOM ttS <br /> Ci State Zip Code Phone Number ❑ City ❑ Village 5� Town Nearest Road <br /> ii�� <br /> �5 oM <br /> [!C New Construction Use: M Residential/Number of bedrooms 3 Addition to existing building <br /> ❑Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 46D gpd Recommended design loading rate�� bed,gpd/ft2— -&_trench,gpdHt2, <br /> Absorption area required 64.3 bed,ft2tren/r,h,ft2 Maximum design loading rate 7 b'ed,gpd/ft2 • & trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s,),�,,.. . / C r'. (Q9• I ft(as referred to site plan benchmark) <br /> Additional design/site.considerations io��:b -cu AI -g eo 1'O b <br /> is— m <br /> Parent material ^ _�FI .UIr1 f 1" Flood plain elevation,if applicable A -ft. - <br /> S = Suitable for system Conventional MoundIn-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system Rs ❑ U ®S EJU N $ ❑ U ®S ❑ U t4S ❑ U ❑S`'MU <br /> SOIL DESCRIPTION REPORT <br /> Bonn # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> 9 Texture Consistence Boundary Roots <br /> In. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> p S EV7 A <br /> 2 9.3M1 3 3 �" l�U QS M S ,Zco .1 S <br /> �Ground 3 �j_(p <br /> ft. <br /> Depth to <br /> limiting <br /> f ctor <br /> 7 in. <br /> Remarks: <br /> Boring# l <br /> 0.12 -7.5twitah <br /> 2 a 212-21 1S49 3 3t& <br /> 7. <br /> Ground <br /> el v <br /> Depth to ✓J o <br /> limiting <br /> f r <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> +c H JW I t IS- 866- 4157 <br /> Addifess 2�7�v6 W>. `I3 Data zz. g CST 36 r <br />