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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 Coun <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and y/1� <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> ®`a fair 03 Zed <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 /> P,I,A Govt.Lot 's 5e- 1/454J 1/4,S/ $ T Y6 ,N,R /57- E(or)(@ <br /> roperty O ner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 6 3 y Sole rxt pr. _ <br /> City State Zip Code Phone Number ❑ Ci Nearest Road <br /> City El �'Town p <br /> -541U o 5 � c A- �/3 5� ( ) 0A-c-k 5 0.0 C o, led, C. <br /> 64ew Construction Use: 5igesidential/Number of bedrooms C;Z- Addition to existing building "— <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 3d O gpd Recommended design loading rate bed,gpd/f12 e_j6 trench,gpd/ft2 <br /> Absorption area required 6 0 bed,ft2 5-0 6 trench,ft2 Maximum design loading rate i �ed,gpd/fi2 _trench,gpd/ft2 <br /> Recommended infiltration surfaceelevation(s) f3. TTT�ft(as referred to site plan benchmark) <br /> Pe Additional design/site considerations Ire-A/4-C--C-17-71 e ti t /I9D4eN Cl <br /> Parent material ��/�y/ � d ri fit— Flood plain elevation,if applicable 4-)r4- ft <br /> S = Suitable for system Conventional ,��M,iorund In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system D&S El L"LS ❑ U ®.S ❑ U I FRI S ❑ U tS ❑ U ❑ S X'U <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 /> 0-6 7iS2jl %rZ fr S S /` <br /> 7i_> ll t� <br /> d d�7 —/S s fit` <br /> Ground 3 S/ 7 ' IQ S <br /> elev. _ <br /> Depth to <br /> limiting <br /> factor <br /> (7�2_in. <br /> Remarks: <br /> Boring # <br /> d � . - '0.;K11 <br /> 3 'D'v , S �P� <br /> Ground ,57AO P;f C AJ fo <br /> elev. <br /> Depth to <br /> limiting <br /> *tor <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> w - �' c�r .2gE <br /> Address Date CST Number <br />