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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Page of <br /> Division,of Safety find 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 /> include,but not limited to: vertical and horizontal reference point(BM),direction and 'Buggr_Tr <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Par cat I.D.# <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Daae / (�yy <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.64(1)(m)). �. V!!(//6 <br /> Property Owner Property Location 1' ; <br /> A5 u�r $W 1/4SU)1/4,S 2j T 38 ,N,R l$ E(or V5 <br /> Property Owner's Mailing Address ,.�• / n Lot# Block# Subd.Name or CSM# <br /> l�0S' 1 /V 7' D <br /> City State Zip Code Phone Number ❑ Ci El village LN Town Nearest Road <br /> KAtnlr$j5U1Z4 W1 D ( 1S)� -2356 0o CRos s�b�.tnl <br /> ❑ New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: AD trench,gpd/ftz <br /> Recommended design loading ' 7 /ft2 • <br /> Code derived daily flow�gpd 9 9 rate bed,gpd <br /> Absorption area required (.4-5--bed,ft2,,J5�trench,ft2 Maximum design loading rate ? bed,gpd/ft2- -%—trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 4 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material GLAaA L Mi 1T Flood plain elevation,if applicable NA ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-GradeSystem In Fill Holding Tank <br /> U = Unsuitable for system 9S ❑ U S ❑ U S ❑ U S ❑ U 1% s ❑ U ❑ s 1%u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon DepthDominant Color Mottles Texture Structure Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. <br /> GPD/ftp <br /> Bed , Trench <br /> l 2 rte-- S OS �S 2y� r? .$ <br /> ff o s <br /> Ground 3u,aq5 R 4 �' M S OS 1 or'— .'� • g <br /> ejey— <br /> Depth to <br /> limiting <br /> fagicA <br /> ? in. <br /> Remarks: <br /> Boring# <br /> r <br /> Ground 4' 041 0-" 5 t( M S w< k �/ • 4 .5- <br /> Oft Oft. <br /> Depth to <br /> limiting <br /> f or <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> 14 �s IS- 866 - 157 e-D <br /> Addre 47760 �� . 7Ia77 tO� �tDate <br /> 9� rl <br />