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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Divisioh of Safety and Buildings Page--L of 3 <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 JBn u/2 NCT/ <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 b Date <br /> te Q <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). l <br /> Property Owner Property Location <br /> NA RYE Sf gU. II Govt.Lot S� 1/4,5-&) 1/4,S /& T N,R /� r(or)W <br /> Property Owner's Mailing Address Lot If Block# Subd.Name or CSM# <br /> n 5q1<e (/r'J6 1 CN cwzc,q A P <br /> City State Zip Code Phone Number ❑ City ❑ Village L 1-Town Nearest Road <br /> SNS L �RRC I W 6- $71 ( /s)y68-�`Fa1 DFcvE it w 64me# <br /> ❑ few Construction Use: RResidential/Number of bedrooms -3 Addition to existing building <br /> Replacement L/� El Public or commercial-Describe: <br /> Code derived daily flow�god Recommended design loading rate r (7 <br /> bed,gpd/ft2--S--trench,gpd/ft2 <br /> Absorption area required gybed,ft2SltOren�h,ft2 Maximum design loading rate_ bed,gpd/ft2 t V trench,gpd/ft2 <br /> �c <br /> Recommended infiltration surface elevation(s) ! 7. y ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material aZAC;A4 iWer-F T Flood plain elevation,if applicable N A ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Gra ga System in Fill Holding Tank <br /> U = Unsuitable for system [Z]S ❑ U ��❑ U ®S ❑ U L(S L� U ❑S LI u ❑ S ®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 /> %� <br /> qej !f17 J <br /> Ground 3 '71 L5--MS S 1 <br /> elev. <br /> L7W ft. 9, L) S-(M, c 3 d 2,r*Z / c S WL — <br /> Depth to 14r rN ,Z,s <br /> limiting <br /> factor <br /> 2 _in. <br /> Remarks: <br /> Boring# <br /> LO 1 f <br /> Ground Y 37-74, ,21.6-YALS X12 _ <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> 22 in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> C�c%L cYtl`8N�i2 c n 7/s- 3f-3 �6 <br /> Address Date CST Number <br /> / o ?-Ale /c ELL b9f< r^ dyg71 3-.;3 .29.2ao 90 <br />