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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page of <br /> Bureau of lategrated 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 andBU 16 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> zo '2S 6j 70o <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)). _/��g <br /> Property Owner Property Location •• .' <br /> dN s Govt.Lot 5+4 1/4 1/4,S 1� T40 ,N,Pt 16 E(or W <br /> PropUrty Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 2 5 oG•� P30 <br /> City State Zip Code Phone Numberto <br /> ❑ City El Village Town Nearest Road <br /> 54 New Construction Use: Residential/Number of bedrooms Z Addition to existing building <br /> ❑ Replacement �,, Public or commercial-Describe: <br /> a <br /> �+ <br /> Code derived daily flow gpd Recommended loading design .7 <br /> g g rate bed,gpd/f12trench,gpd/ft2 <br /> Absorption'area required 42.9 bed,ft2 3?s tr ch,ft2 Maximum design loading rate .7 bed,gpd/ft2 .$ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s)' Q>.6 Am (as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material CI IA( ielfT Flood plain elevation,if applicable AA ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT'Grade System in Fill Holding Tank <br /> U = Unsuitable for system S ❑ U S ❑ U S ❑ U S ❑ U V s ❑ U El X{ U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence Boundary Roots <br /> in. Munsell Cu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> 1 d-S7-NK arLr- �_ s 63 <br /> �GIrroLu�nd 3 33•(Al — MS #A,� /"- '.Z.Gc <br /> Depth to <br /> limiting _ <br /> f r <br /> � Lin. <br /> Remarks: <br /> Boring# <br /> 04 M1 t�-S .,� ,� .8 <br /> 2 2- S-31 7&IN <br /> 3 :Zc o •1 <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> f r <br /> ln. Remarks: <br /> CST Name (Please Print) Signature Telep <br /> ARn 74S- 6- 4157 <br /> Ad ess Dat CST N mbar <br /> s st�•a tr`I1.54893 -lo • 00 00S <br />