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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 County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and 4 e h e- <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# ) <br /> I r4r7� (��.Q ��3 j X03 fOW <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 /> 6 f 0.V6 p>°f�r SQ JIA Govt.Lot? Sty/ 1/4 I!/014,S ?r T L{O,N,R 16 E(or& <br /> Property Ow er's Mailing Address Lot# Block# Subd.Name or CSM# <br /> x.73-7i E. Vev; (s GIS. KUL <br /> City State Zip Code Phone Number ❑ City ❑ Village g [K Town Nearest Road <br /> New Construction Use: Residential/Number of bedrooms 3 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow SU gpd Recommended design loading rate r—7 bed,gpd/ft2 151 trench,gpd/ft2 <br /> Absorption area required to�',3 bed,ft2 �_63 trench,ft Maximum design loading rate r `7 bed,gpd/ft' �trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 97 8 ft(as referred to site plan benchmark) <br /> Additional design/site considerations �n <br /> Parent material /w�ia tiff Flood plain elevation,if applicable AIA 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 WS ❑ U ❑ S ® U ❑S CKLI ❑ S U ❑ S IRU <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles _Structure GPD/ft2 <br /> 9 in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh._ Consistence Boundary Roots <br /> Bed , Trench <br /> ll d ro -75-Y % — / ass ry, l 9s ) f , 7 .� <br /> vj o-30 7,5-t-n V/ rh S cps i" l $s 1 e ve 17 ' <br /> Ground 3I 7,S-'rd f/y -r/r G 1+✓ <br /> elev. <br /> �rft• ' <br /> Depth to <br /> limiting <br /> factor <br /> 36 in. <br /> Remarks: <br /> Boring# ' o-iU '7,5 Y2 % /s oS,$ M ! S S �F 1 -7 <br /> , g <br /> ;v-3 7siR `�/6 n,S o s vy l 5f t 1"K r 7 .6 <br /> Ground <br /> elev. <br /> 9Gsft. <br /> Depth to <br /> limiting <br /> ct r <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> c1i90)E5_ S 0,4-V S S� 7rS- �1(0�-- 9 iJf 7 <br /> Address Date CST Number <br /> 7740 3S PV-4. f ry S'� P 9— g 7���r!' <br />