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Wisconsin,Department of Commerce SOIL AND SITE EVALUATION <br /> Divislorof Safety and Buildings pa _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 812 x 11 inches in size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and I VURA45T <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. p I.D..# <br /> D��- <br /> APPLICANT INFORMATION-Please print all infamadYon. Reviewed by Data <br /> Pewr al information you provide may be used for secondary purposes(Privacy taw,s.15.04(1)(m)). - 9 d <br /> Property Owner Property Location C! <br /> u CE Ai?91V Govt Lot 1/4 1/4,S �3 T40 ,N,R E(orW� <br /> Properly Owner's Mailing Address Lot# BlocMeSubd.Name or CSM# <br /> 17/9 Los LA DR- 13 KlLkwe GiRi�erJ ADD_ o y_✓_ <br /> City State Tip Code Phone Number ❑ Qty ❑ ViAagf `4 Town Nearest Road <br /> ���ryLAdTA 60 RPA FL.- 3 $D ( 941 )575—ZZ $ACK [J <br /> M New Construction use: Residential/Number of bedrooms 3 Addition to existing building <br /> n Replacement ❑Public or commercial-Describe: <br /> Code derived daily flowgpd Recommended design loading rate •7 _bed.gpddflz . g french,gW? <br /> Absorption area required bed,ft2663 .ft2 Maximum design loading rate—,7—bed,gpoln2 .—Strench.gpd/(t2 <br /> Recommended infltiretion surface elevatton(s) 9 S.4 U-1 Act: Sys_ IN Fit. . ft(as referred to site plan benchmark) <br /> Additional deeign/s/i+te considerations <br /> Parent material l4LACI AL PgWf• Flood plain elevation,it applicable <br /> S = suitable for system Conventional Mound In-Ground Pressure AT-Grade System in FN Holding Tank <br /> U = unsuitable for system ®s ❑ u WI s ❑ u t4s ❑ u I Ws El u ®s ❑ u ❑s ® u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Struture Consistence Y Rco� GPD/ft2 <br /> in. Munsell Qu.Sz.Cont Calor Gr.Sz.Sh. Bed ,Trench <br /> 0 I S R Z r r C 2✓ <br /> 2 <br /> 6-.0 . _G r c o 7 S <br /> Ground 38,z-d 5 s <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> 2 Z 1 2 �� 15 vim, l c o '7 ; . <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> CST Name (Please Print) XL <br /> Telephone No. <br /> 1C�f{1Rp I�D PWlc�ni4 '�IS' 4KI <br /> Address Date CST Number <br /> 27 60 3� �BsrER yJl, S4 3� ]3— 48 b7a <br />