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Wiscugsin Department of Commerce SOIL AND SITE EVALUATION Page—i—of <br /> Division of Safety and Buildings <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 /> Turn(f� <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 /> 03N- IS> a -oa soo <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Date pp! ) <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(l)(m)). <br /> Property Owner L Property Location IP I n <br /> Govt.Lot 1 :U4—W ,S 1 a T 3-7,N,R l b E(o <br /> Property Owner's Mailing Addr ss Lot# Block# Subd.Name or CSM# <br /> City State zip Code Phone Number ❑ City ❑ Villag Town Nearest Road <br /> Rdl <br /> C..O{,t`){l S} •Pcru) (}1 N SSD"1 ( �i a) us)-acb� 7'rad C S i r i fLakz° �CCt55 <br /> ❑New Construction Use: Ip Residential/Number of bedrooms c Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow <br /> 300 gpd Recommended design loading rate NR'bed,gpd/fF NA- trench,gpd/f12 <br /> n I <br /> Absorption area required IJ A- bed,ft2 NA- trench,ft2 Maximum design loading rate NA- bed,gpd/ft2 "�A trench,gpd/ft2 <br /> ft <br /> Recommended infiltration surface elevation (as referred to site plan benchmark)s) 1_ �yyf �,, <br /> Additional design/si/nt�econsideration �5u�tCl�r A� MIC-4feQW " �'Qf k5 +0Si+e QgV!0 YM <br /> Parent material A h L i Q 1 _Dr I;} Flood plain elevation,if applicable N A ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill NIS Ho iing Ta U <br /> U = Unsuitable for system ❑S U ❑ S % U E) S [ U ❑S U El U <br /> SOIL DESCRIPTION REPORT <br /> Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/tt2 <br /> Boring # Gr.Sz.Sh. Bed Trench <br /> in. Munsell Qu.Sz.Cont.Color <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> factor <br /> in. <br /> Remarks: 4 No bor`iM <br /> Boring# <br /> Ground <br /> elev. <br /> _ft. <br /> Depth to <br /> limiting <br /> factor <br /> in. Remarks: <br /> Signature Telephone No. <br /> CST Name (Please Print) <br /> S <br /> Address Date CST Number <br />