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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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> od6Y/% o foo <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 /f�� / Property Location <br /> A6ee C E r^ Govt.Lot /uE 1/4N(,_/1/4,S T j, ,N,R 7 E(oe <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> ,7V '310 Sw e ti so,J 41 — — — <br /> City State Zip Code Phone Number ❑ City l <br /> r g Town Nearest Road <br /> L.JeGSl�er AJC 5-V9lY ( > �nJ•�lS �N �e/` <br /> New Construction Use: CAResidential/Number of bedrooms –3 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: --- <br /> Code derived daily flow ���gpd Recommended design loading rate a bed,gpd/ff2 _16" trench,gpd/ft2 <br /> Absorption area required to Y 5— bed,ft2 3 -1 trench,ft2 Maximum design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 91021.45— ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material rr 44 c A--1 J h/ Ff Flood plain elevation,if applicable AZIA ft <br /> S = Suitable for system rCdonventional Mound In-Ground Pressure AT-Grade System in Fill Holding[Tank <br /> 2- <br /> U = Unsuitable for system S ❑ U E5 El U � ❑ ❑U as U S ❑ U ❑ SU <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> 9 Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> ,A <br /> Ground yk 71 / <br /> elev. , <br /> Depth to <br /> limiting <br /> facto <br /> ��in. <br /> Remarks: <br /> Boring # <br /> Ground <br /> elev. <br /> Depth to <br /> limiting ^ '_ <br /> factor <br /> y Z in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br /> -1 ---,27Gr"/ <br />