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Wisconsin Department of Commerce SOIL AND SITE EVALUATION Pa1 of y <br /> Division of Safety and Buildings 9e 3 <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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 02$- &+12-4- oL2- 300 <br /> APPLICANT INFORMATION - Please print all information. Reviewed by Date /s <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.75.04(1)(m)). <br /> Property Owner Property Location I — / <br /> Ct�P a aFs rh R'y', Govt.Lot 5 1/4 1/4,S7.4 T N,R 'f==W <br /> Property Owner's Mailing Address t#' Block# Subd.Name or CSM# <br /> It 3o 6be*a* r?,&ac ---�-7 1 )&-bs p6c.-S <br /> City State Zip Code Phone Numberrty ❑ Village Il Town Nearest Road <br /> aneY L)I I otk ba.Q' <br /> ❑ New Construction Use: IZResidential/Number of bedrooms 7-• Addition to existing building <br /> g Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 3pO gpd Recommended design loading rate gibed,gpd/ft2 trench,gpd/ft2 <br /> Absorption area required 4XI bed,ft2 37S trench,ft2 Maximum design loading rate •7 bed,gpd/fl2 •-8trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 3.:J; h(as referred to site plan benchmark) <br /> Additional design/site considerations r <br /> � <br /> Parent material I ACA - CI 1U' Flood plain elevation,if applicable ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system I S ❑ U ❑S ZrU ❑ S 0 U ❑ S �U ❑S .❑ U ❑S f;-rU <br /> L;4 a tilt 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 /> I tl -7.5YR ¢ 1lawd M CpJ 3J1 -7 B <br /> rb-dab 3M •7 ,• 8 <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: . S.E + <br /> Boring# <br /> tH'v ea.Jz .. 8 <br /> 2 3-IZ t.SYQ `{I Q ittM . -7 F1 <br /> Ground <br /> Alev <br /> Depth to <br /> limiting <br /> factor r <br /> _in. �emarks: E f <br /> CST Name (Please PrintSEPTIC & EXCAVATION S1916ature V Telephone No. <br /> N6228 Cou Line Rd. <br /> Address (715)1635-7482 Date CST Number <br /> � as sY as X979 <br />