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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division 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 B uRNierr <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Pa el I.D.# <br /> oil 950D % 10D <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)). 40—Property Owner Property Location [v <br /> Govt.Lot 1/4 1/4,S Z3 T40 0 ,N,R 1S E(or)(9 <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> z 1- V6>?-LAlN` O 01 . <br /> City State Zip Code Phone Number Nearest Road <br /> I_5A(aIdjiW �, ( �'$� ❑ City ❑ Village Town <br /> 345-(05?4 �tcKSvrJ 2• WA\/ <br /> New Construction Use: YlResidential/Number of bedrooms 2 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow Soe) gpd Recommended design loading rate •1 bed,.gpd/ft2 -S trench,gpd/ft2 <br /> Absorption area required 4:701 bed,It 37<* tre ch,ft Maximum design loading rate bed,gpd/ft2 •$ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) $ ALr. 94.7— it(as referred to site plan benchmark) <br /> Additional design/site considerations / <br /> Parent material l'li as c T)RlkT Flood plain elevation,if applicable /yfj If <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ®S ❑ U I ❑ U KS ❑ U 2]s ❑ U ❑ S ,;K 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. qq Bed Trench <br /> - I •/ 55WaJr IL A4 Lis /GO '1 .$ <br /> AAl 5 co S <br /> Ground ' 21-15 S rayl r` ? <br /> lev <br /> %J ft. <br /> Depth to <br /> limiting <br /> factor <br /> 77$• in. <br /> Remarks: <br /> Boring# <br /> 1 4, Ifia <br /> 2`' Z 6-32 7.5w g & -ti . 7 <br /> Ground <br /> elev. � l+r <br /> Depth to <br /> limiting <br /> factor <br /> )A5 in. Remarks: A <br /> CST Name (Please Print) Signature Telephone No. <br /> Y�4CAARJR <br /> Address Date CST Number <br /> ,7_11W Hwy fo5rrg W t.S4$g3 (, 1&- 99 22 SSSI <br />