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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 S 1/2 x 11 inches in size. Plan must County <br /> inpltide,but not limited to: vertical and horizontal reference point(BM),direction and 4Jr/t%e-11— <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 may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> N / Govt.Lot 1/4 1/4,S T � ,N,R�� E(oro <br /> Property Owners Mailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Coe Phone Number <br /> ❑ City El Village [Z Town Nearest Road <br /> '01 <br /> P/60 4--o.,J AA) ^� /le e <br /> El New Construction Use: �esidential/Number of bedrooms _ c Addition to existing building <br /> Replacement LJ Public or commercial-Describe: <br /> Code derived daily flow gpd _ Recommended design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> Absorption area required j6 00 bed,ft2 S d 0 trench,It Maximum design loading rate -116; bed,gpd/ft2i e trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) _ y Q, D ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material Gbf< Flood plain elevation,if applicable 4119- ft <br /> S = Suitable for system Conventional rrMound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> ®, <br /> U Unsuitable for system S Elc <br /> U ILLS ❑ U ®s ❑ U 1 2S.3 ❑ U Z'S ❑ U ❑ s au <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 /> 3/a ms�� c 3 -3ed ' 2 . <br /> Ground e, Yf,� 5 S� K f r <br /> ele <br /> It <br /> Depth to <br /> limiting <br /> factor <br /> min. <br /> Remarks: <br /> Boring # <br /> d'r6 T5 <br /> 73 'glf 14 <br /> Ground <br /> elev. <br /> /Oi91 3 ft. <br /> 4 ' <br /> Depth to <br /> limiting <br /> factor <br /> 7Zain. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Addres t Date CST Number <br /> 7e ,3_1Sire✓t% LJ .5— g7,2 ;� 5_�?3 <br />