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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of SefMy and Buildings Page�_of 2- <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 andwrY1¢ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 02 -3//S= 6/-6 00 <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Dat n <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 7�7 <br /> Property Owner Property Location <br /> _D9OWltS Govt.Lot OE 1/4 ()E1/4,s IS Tay ,N,R 14 E(or <br /> Property Owner's Mailing Address ,�n Lot# Block# Subd.Name or CSM# <br /> Z/o31oS =T-VIAioK+ 7 • 0k4.V .��, <br /> city State Zip Code Phone Number ❑ city ❑ villaZ Town Nearest Road <br /> LO; 1 15 01 ( ) 1 <br /> e k5k 6 A n r4V"_.A& <br /> �] New Construction Use: ZResidential/Number of bedrooms ?A-j%f�N Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow lL1,J gpd Recommended design loading rate . Z bed,gpd/fl2. S trench,gpd/fl2 <br /> Absorption area required bed,n2 "t trench,n2 Maximum design loading rate - -7 bed,gpd/ft2 •$ trench,gpd/n2 <br /> Recommended infiltration surface elevation(s) 4904-01 ft(as referred to site plan benchmark) <br /> Additional design/site considerations- &rw Q"% LDo.a' Ootit- ..1,..14"1&A OA1c'YrG¢l 5% S-L-8pE <br /> Parent material r Flood plain elevation,if applicable�L ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ZS ❑ U ❑ S ❑ S [ u ❑ S El U ❑ s Zru ❑ S OU <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> 9 Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> ix,o-n a 6++.s er 8 <br /> 1-114 -t•6�(L z o-tn,e JLA71�t iw.J r I J t� .? •4 <br /> Ground 14-10 -t-GYP-414 a ca> 1� rK Z •S <br /> ev. <br /> '►0fc. �} -10. .S R.►I 1 8 <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: 1r02 ?& Qn�r$ �oxM on1.. <br /> Boring # <br /> 6 2t d <br /> r , <br /> Ground <br /> elev. <br /> n. <br /> Depth to <br /> limiting <br /> factor <br /> in. Remarks: <br /> CST Name (Please Print)--- Si ture Telephone No. <br /> .N\ _L ,a,StM <br /> _tA:tl� <br /> Address �G /� 1 Date CST Number <br /> b=8 n two IJ IrW/ Wi 514901 -?QVC 7 <br />