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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 �3updgrr <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. p cel I.D.# <br /> 03 R 30 <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)). <br /> Property Owner Property Location <br /> RIA Govt.Lot 1/4 1/4,S 23 T40 ,N,R 16 E(or(w) <br /> Property Owners Maili g Address Lot# Block# Subd.Name or CSM# <br /> 0�` S . 5T= !1+� I ooKVOL, - 13 <br /> Ci State Zip Code Phone Number ❑ City ❑ Village 19 Town Nearest Road <br /> I <br /> New Construction Use: X Residential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 460 gpd Recommended design loading rate 7 bed,gpdtht • g trench,gpd/ft2 <br /> Absorption area required 043 bed,ft2✓/ trench,ft2 r Maximum design loading rate 7 bed,gpd/ft2 L $ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) '7 � �7. !/ ft(as referred to site plan benchmark) <br /> Additional design/site considerations MA// <br /> Parent material 1',wdAL, DAf'T- Flood plain elevation,if applicable�vA ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S ❑ U WS ❑ u V S El Vs ❑ U S ❑ U ❑S 19RU <br /> SOIL DESCRIPTION REPORT <br /> Bonn # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots Bed , Trench <br /> 7 <br /> zi <br /> Ground <br /> I v. <br /> S 44 .7 S <br /> Depth to <br /> limiting <br /> fa or <br /> Remarks: <br /> Boring # <br /> S 7 ,rr3 2 v` AS �XM 1otr e-o 7 ; 6 <br /> 37Z_k 1465 <br /> o 1M . 7 $ <br /> Ground /! �— r `— <br /> lev. <br /> Depth to <br /> limiting <br /> ,2Kfa for <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> I c l♦RRp PKIlJS I S - S <br /> Addr ss�7 7 p0 3�• *o I i - Date C Number <br />