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'Nisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> t'.tision c4-Safety and Buildings Page of <br /> f#ueau 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 _SU-gwdTr <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> Hca <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 /> BOB ptJ Govt.Lot 1/4-- 1/4,S T41 N,R ij E(oO <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number <br /> ❑ City El Village �I Town Nearest Road <br /> LEXrr44ror-4 1 M?41550141 (l M)7S(g-9ZO1 W.D LK_ rev. <br /> ❑ New Construction Use: W Residential/Number of bedrooms 2 Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 0 0 gpd Recommended design loading rate • 7 bed,gpd/ft2 •$ trench,gpd/ft2 <br /> Absorption area required bed,ft2 3 7 S trench,ft 01 <br /> Maximum design loading rate bed,gpd/ft2. <br /> _trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) q L • ft(as referred to site plan benchmark) <br /> Additional design/site considerations -/ <br /> Parent material a LA W4 L Q f F-r Flood plain elevation,if applicable !✓A ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system %i S ❑ U Ns ❑ U $,I S ❑ U 5aS ❑ U Vs ❑ U ❑ S �K U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring Texture Structure Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> Z 4.33 7.5 a '4 ^--- 14; :7 .$ <br /> Ground 3pj. ?.S 5 •$ <br /> vb ft. <br /> Depth to <br /> limiting <br /> fa for <br /> 7�in. ' <br /> Remarks: 1-tAdn A%464 'AvxXj 4e <br /> Boring# <br /> Z X4.30 1. rr 4 <br /> _ _ 3 7.51 R S �—� ;7 <br /> Ground <br /> Depth to <br /> limiting <br /> factor <br /> 7in. Remarks: AAub AU a& 130AnJ 1. <br /> CST Name (Please Print) Signature Telephone No. <br /> 144A490 b r �s- 866. +IsI <br /> Ad ress Date CST Number <br /> 2? ol4t4v .16A. 54915 -7-7 , 10 27.s 8511 <br />