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111•isconsrn uepartment or t-ommerce SOIL AND SITE EVALUATION <br /> Civision or Safety and Buildings Page of <br /> Fsureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code <br /> 4 <br /> Attach complete site plan on paper not less than B 1/2 x 11 inches in size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D. # <br /> APPLICANT INFORMATION - Please print all information. Reviewed by Date <br /> Personal information you provide maybe used for secondary purposes(Privacy law,s.15n74(1)(m)). •- <br /> Property Owner Property Location <br /> �O1T Govt.Lot.3 1/4• 1/4,S T ,N,R 14 E(or 'f/ <br /> Property Owners Mailing Address Lot# Block# Subd.Name or CSM# <br /> - <br /> city State Zip Code Phone Number City ❑ Village Town Nearest Road <br /> Fll tJ. 1554311 (6 ass'r-00 S Co. Tzn. r <br /> ANew Construction Use: Residential/Number of bedrooms 3 Addition to existing building <br /> ❑ Replacement Public or commercial-Describe: 44 <br /> Code derived daily flow gpd Recommended design loading rate • bed,gpd/ft2 .[[� trench,gpd/ft2 <br /> Absorption area required bed,ft2 0 trench,ft Maximum design loading rate bed,gpd/ft2_,(Z_trench,gpd/ft2 <br /> Recommended infiltration surface elevations) IDI 3 ft(as referred to site plan benchmark) <br /> Additional design/site considerations Aftwo Su1TAat•f As 9 f ePL4e6yxyT BSS .I <br /> Parent materia) -GLACIAL w cr Flood plain elevation,if applicable 1VA ft <br /> S Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system CS <br /> X u % S ❑ u ❑ S Xu ❑ S u ❑ S u ;9 S u <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Structure C-pD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed , Trench <br /> _i <br /> 0-3 •s z ^-- all <br /> Z 4 7 �r <br /> Ground 114 � /' J J K AA 5 s s . 6 <br /> evr <br /> Depth to <br /> limiting <br /> f for <br /> Min. <br /> Remarks: <br /> Boring # rr <br /> r 0-3 <br /> 15 L <br /> Ground <br /> e ' <br /> Depth to <br /> limiting <br /> -f ctt <br /> in. Remarks: <br /> CST Name !Please Print) Signature Telephone No. <br /> Je'4ARo o rlS f 15- �06- S <br />