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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division Ot Safety and Buildings Page—of— <br /> Bureau of Integrated Services in accordance with s. ILHR 83.09,alis.Adm.Code <br /> Attach complete site plan on paper riot less than 812 x 11 Inches In size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and u RNgTr <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest mad. Parcel I.D.# <br /> 0/1/- ) ;2a9- d� - 306 <br /> APPLICANT INFORMATION-Please print all 6rMrma&m. Reviewed by we <br /> Personal infonnabon you provide may be used for secondary pub(Privacy Law,s.15.04(1)(m)). 7� _////7h <br /> Property Owner Property Location vV <br /> ELSE GdwL Lot 1/451' 1/4,S 2Z Tj$ ,N.R E(orj(�) <br /> Properly s Mailing Address Lot# Block# I Subd.Name or CSM# <br /> 4219 M Rr�- B IW qcRE5 <br /> City State Zip Code Phone Number ❑ City ❑ ydflage Town Nearest Road <br /> 5 I RI ►W 1 WIfyWM ( 15 )4 %-VJ 9 co . 2D 8 <br /> M New Construction Use: %Residential/Number of bedrooms 3 Addition to existing budding <br /> ❑Replacement ❑Public or commercial-Describe: <br /> Code derived daily flower gpd Recommended design loading rate . 15 bad,gpo*_trench,gpdfn2 <br /> Absorption area required _bed.ft2 n2 Mabmum design loading rate -� bed,gpdAt2�trsnch.gpolftz <br /> Recommended iMlltratlon surface elevation(s) 8.3� AGT. (as referred to site plan benchmark) <br /> Additionaidesigrdsiteconsiderations CpRL UPPER !CErrl-I STONER oni- SrrE <br /> Parentmaterial GLA AAL D RIfr Flood plain elevation,If applicable Me n <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grime System in Fill! Folding Tank <br /> U unsuitable for system ®s ❑ u ®S ❑ u 1 ®S ❑ u I ®S ❑ u ®s ❑ u ❑s [RU <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 ,Trench <br /> ( I 0-5- 7.3\19 z �-- fs lom 51 hi C S 7✓� .�; :, G <br /> Z 5-58 7•S((R 4 4 --_ fs om-sa nal // CS M .5' : .6 <br /> Ground 3 $$-G 7. R 4 4 T Igig M� 1 t '— M 4 , .S <br /> elev. <br /> ll tL <br /> Depth to <br /> limiting M f rf r , <br /> in. <br /> Remarks: <br /> Boring# <br /> I 2'4 <br /> El <br /> Z 6-58 7-SUP 414 s DMS M I CS 1 d'o .S G <br /> 3 Sb(w 7. p' 4 G2dRS $ S <br /> Ground <br /> elev. <br /> I�•Lft <br /> Depth to <br /> limiting <br /> falov <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> /L RP /S- - 41,57 <br /> Address/ 27 7loo l{w 3� (�L-BS7�,2 L�lr. X893 _q7 �3 Number <br />