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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page of <br /> Skireau 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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. pa el I.D.# <br /> 03Z630 01 104 <br /> APPLICANT INFORMATION -Please print all information. Reviewed b 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 /> LOU IS Govt.Lot 1/4 1/4,S V T N,R 1(, E(o OW <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 1422 f I FM 5r IQ •£ <br /> City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road <br /> 5 131 IS SS LX- ►>. <br /> New Construction Use: XResidential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flowA. Z) gpd Recommended design loading rate 1 bed,gpd/ft2 .�trench,gpd/ft2 <br /> S <br /> Absorption area required _bed,ft2 5/((►o3-7 • d,gp <br /> trench,ft2 Maximum design loading rate � bed/ft2 $ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) r1 s• ( It(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material 6LACIAL 1221 ' Flood plain elevation,if applicable NA 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 M s ❑ u cgs ❑ u 1-gs ❑ u Ms ❑ u Els $ u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Texture Consistence t3ouhdary Horizon Depth Dominant Color Mottles Structure Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> 4 <Aliq Z 65 t o q 8 <br /> 2 32 3-5-49 4 IL 5S KI q5 1 eo 7 $ <br /> Ground 32-76 F41 A� <br /> 1 <br /> ft. <br /> Depth to <br /> limiting <br /> fa or <br /> Remarks: <br /> Boring # <br /> 2 v^ 1.5 It 6 ~� Ns ? •8 <br /> 3U,1A <br /> Ground <br /> Iev 3 <br /> Depth to <br /> limiting <br /> factor <br /> )],j- in. Remarks: RIA 80121b)4— <br /> CST Name Please Print) Signature Telephone No. <br /> ! C N)A RD o ( S- b- <br /> Address J��42 Date CST Number <br /> '1 <br /> 2 '7(oO }•{,,,f 35 ukj3s lE 2 t�l , S + 13 - 11 2z515 <br />