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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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.If c3 <br /> 0/;2 7075` r!� —?, c7Vu <br /> 9a d <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 /> Pr c- �f 5 Govt.Lot 1/4 1/4,S T ,N,R / – E(o W <br /> Property Owner' ailing Address Lgtt# Block# Subd.Name or CSM# <br /> t � / <br /> ,15217C c /iv ]Lo cad o 7-m,A5 yi'.e 7,/, 1�d� �o <br /> City Stateip Code Phone Number <br /> �L Nearest Road <br /> City Village Town / <br /> (�New Construction Use: Residential/Number of bedrooms 2 Addition to existing building ~� <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow ��� gpd ✓ Recommended design loading rate P 7 bed,gpd/ft2 < g trench,gpd/ft2 <br /> Absorption area required y�9 bed,ft2 c 5 trench,ft2 / Maximum design loading rate � %bed,gpd/ft2 _ � trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 7Y, �ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> r <br /> Parent material � i¢C iA- ddA/LY`"� Flood plain elevation,if applicable n.Jr ft <br /> S = Suitable for system Conventional rM��ound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system 9 E3 19S ❑ U N ❑ U MS ❑ U as ❑ U ❑ S Mu <br /> SOIL DESCRIPTION REPORT <br /> Boren # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> x q <br /> yyp � u�✓` 5 7 , <br /> Ground 78 7 7 �— 5 .r�/J/ cam <br /> elev <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# / <br /> ,3 /P 7 d' <br /> Ground <br /> ele�c� <br /> Depth to <br /> limiting <br /> factor <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br />