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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 'Sar <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> 01..E 196 <br /> APPLICANT INFORMATION - Please print all information. Reviewed by //„n Date <br /> Cs` <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). .` L!/�TL�//- 7 <br /> Prop rty Owner Property Location <br /> �e F� Govt.Lot.Z Siff 1/41Vtd 1/4,Sag T ya ,N,R 16— E(or)(@ <br /> Property—Owner's Mailing Address / Lot# Block# Subd.Name or CSM# <br /> O 'S Gec.F r1 6;,G,02 <br /> City State Zip Code Phone Number <br /> ❑ City El Village CK Town Nearest Road <br /> e,A fet5_YF7,? i ( )966 Sy37 '�'rAC.k5a-'o I LreC/ U <br /> ❑ New Construction Use: i 4FIesidential/Number of bedrooms - Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow .SO gpd /ft2 Recommended design loading rate •7 bed,gpd ,eE trench,gpd/ft2 <br /> Absorption area required 61Y 3 bed,ft2 sb/3 trench,ft2 Maximum design loading rate iZbed,gpd/ft2_o_g?_trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material C%IQ d r l r�- Flood plain elevation,if applicable <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system1% S u S ❑ U Xs ❑ U ;9�s Elu S ❑ U ❑ S Ta�tl <br /> SOIL DESCRIPTION REPORT <br /> Boris # 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 /> 7,stip 15 bt;mAk <br /> o? F'4.,701 7,syiP / /moi afo- <br /> Ground /A 7 5'1.e F ` Gr-5 1S elev. loe <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> 2 <br /> Ground <br /> eJn. <br /> Depth to <br /> limiting <br /> factor <br /> ->20-in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> /�)Ad,� r�o ?5;�—;;!-2 orl� <br /> Address Date CST Number <br /> e,A- '99 <br />