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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 �l�PIfFR <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. par el I.D.# <br /> Z 21`i -10 <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)). - _6_ <br /> ?L`7 <br /> Property{Owner �p {� Property Location <br /> RF, C 'I,uM t' DSR L^lKI Govt.Lot w 1/4 sf� 1/4,S J9 T L`.� ,N,R IS E(ore <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> At £n1T' 51-_ 3 5ACRES VLA . 213-Z(A <br /> City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road <br /> ���,,,ttt ►J . �p0� 6- 225 t�1 55 <br /> New Construction Use: Residential/Number of bedrooms Z Addition to existing building' <br /> ccc,,,�� ' <br /> Replacement Public Pr commercial-Describe: <br /> Code derived daily flow 306 gpd Recommended design loading rate ' bed,gpd/ft2 .$ trench,gpd/ft2 <br /> Absorption area required QZq bed,ft 315nn trench,ft2 Maximum design loading rate bed;gpd/ft2 •g trench,gpd/ft2 <br /> Recommended infiltration surface elevations} 95 .S . <br /> ft(as referred to site plan benchmark) <br /> Additional design/site/considerations M <br /> Parent material GLACIAL V9Vr Flood plain elevation,if applicable IVt1 ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S ❑ I ERS [:1 U ®S ❑ U S ❑ U S ❑ U ❑S 1,5�U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed , Trench <br /> 0-5 JALJR 3 GS I co 7 g <br /> 5 o R A Is 1 (.0 ; .S <br /> Ground 3 0- S. S 4 NS ©5 rte— m <br /> e v ; <br /> Depth to <br /> limiting <br /> faQtor <br /> 7in. <br /> Remarks: <br /> Boring# <br /> -5 7 R 2 Ms OS Al CS 1co 1 <br /> S JcS 5 114 is I co z 'd <br /> 3K 5 4 �J MS o s P&I wt ? 8 <br /> Ground <br /> Depth to <br /> limiting <br /> fa or <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Ic#A2v g"4�-d JS. %6- 4J5 <br /> Adbress Date CST Number <br /> '(7�0 /4W �. W� . 54�9� G- - 19 �-2sds1 <br />