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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 81/2 x 11 inches in size. Plan must County � / <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and /n /U e,/ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Peel I.D.# <br /> /33 0 l -3/0 <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 /s <br /> e /1 /9 A) Govt.-lot SGcJ 1/4',V,�-1/4,s 33 T 4/O,N,R f/ E(oe <br /> Property Owner4AIalling Address Lot# Block# I Subd.Name or CSM# <br /> a 7 X2 6 G o, J. <br /> City State Zip Code Phone Number 11 city Elvillage Town Nearest Road <br /> e 5 er Lrl,Z S" 93 ( ) 3S- -5-Cg, <br /> ❑ New Construction Use: ZResidential/Number of bedrooms —2 Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 3o b gpd Recommended design loadingrate . S <br /> req bad,ft2 Soy 2 9 g _bed,gP���trendt,gp W <br /> Absorption area wired O U trench,ft Maximum design loading rate 5 bed,gpd/ft2 f e trench,gp W <br /> Recommended Infiltration surface elevation(s) 193, 7 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material 0/4 e%R-/ Flood plain elevation,if applicable /U"V- ft <br /> S = Suitable for system Conventional Mound in-Ground Pressure AT-Grade System in FII Holding Tank <br /> U unsuitable for system 51 s El 198 El XS El as ❑ U ®,s ❑ 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 ,Trerx*l <br /> 1 1 )-1111 7.5 YR 3/2 ---------- is lmsbk mvfr cs3f-co .7 .8 <br /> 2 11 '-16' 7.5 YR 3/4 ---------- scl 2msbk mfr gs 3f-co .4 .5 <br /> Ground 3 1 "-7911 7.5 YR 5/6 ---------- fs Insbk mfr -- 2f .5 .6 <br /> elev. <br /> 9fi.bft. ; <br /> Depth to <br /> limiting <br /> factor <br /> > 79'in. ; <br /> Remarks: <br /> Boring# <br /> 1 0-1111 7.5 YR 3/2 ---------- is lmsbk mvfr es 3f-co .7 .8 <br /> 2 2 11"-20" 7.5 YR 3/4 --------- scl 2msbk mfr gs 3f–co .4 .5 <br /> 3 20"-76" 7.5 YR 5/6 ---------- fs lmsbk mfr -- 2f .5 .6 <br /> Ground <br /> elev. <br /> 95.811t. <br /> Depth to <br /> limiting 93.- <br /> factor 40 <br /> >761n. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Wade Rufsholm (715) 349-7286 <br /> Address Date CST Number <br /> 24702 Lind Road Box 514 Siren, WI 54872 10/8/97 3583 <br />