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Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of <br /> Division of Safety and Buildings in accord with Comm 83.05,Wis.Adm.Code <br /> Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must County <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and Burnett <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Parcel I.D.# <br /> APPLICANT INFORMATION - Please print all information. _ 028-9175-02-200 <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.16.04(1)(m)). Reviewed By Date <br /> Property Owner Property Location <br /> Anderson,Bonnie Govt.Lot SW U4 NE 1/4,S 9 T 40 ,N,R 14 W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 1/7 6vG57 12 Lukes Woods <br /> City State Zip Code PhoneNumberL City [Village ZTown Nearest Road <br /> SSyOg' J12-son- <br /> 12- 2-7241 Scott CountyH <br /> ❑ New Construction Use: Residential/Number of bedrooms 2 ❑Addition to existing building <br /> ❑ Replacement ❑ Public or commercial describe <br /> Code Derived daily flow 300 gpr Recommended design loading rate .6 bed, gpd/ftz 7 trench, gpd/ft2 <br /> Absorption area required 500 bed,ftz 429 trench,fy Maximum design loading rate .6 bed, gpd/ftz .7 trench, gpd/ft' <br /> Recommended infiltration surface elevation(s) 92'-7"/?2--59 ft(as referred to site plan benchmark) <br /> Additional design/site considerations Conv Bed 12x 42 <br /> Parent materialGlacial Outwash Flood plain elevation,if applicable N/A ft <br /> S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U=Unsuitable for system E ❑ U ® S ❑U 7 S ❑ U ® S ❑ U ❑ S ® U ❑ S ® U <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Structure GPD/ft' <br /> Borin Horizon Texture Consistent Boundary Roots <br /> g� in. Munsell Qu. Sz.Cont. Color Gr. Sz. Sh. ! Bed Trench <br /> 1 1 0-4 7.5YR3/2 none is <br /> 2 5-72 7.5YR5/6 none s <br /> Ground <br /> elev <br /> 95'-7"ft. <br /> Depth to <br /> limiting <br /> factor <br /> >72" <br /> Remarks: Hand Augered Bore <br /> 2 1 0-4 7.5YR3/2 none is <br /> 2 5-77 7.5YR5/6 none s <br /> Ground <br /> elev <br /> 96' ft. <br /> 1 <br /> Depth to <br /> limiting At 49„ha 3'clay balls see Bore#5 <br /> factor <br /> >77" <br /> Remarks: Hand Augered sore <br /> CST Name(Please Print) Signature: Telephone No. <br /> Wayne Nutt ��-e 7/S-a S 4 -2 3 G 6 <br /> Address , / Date CST Number Ref# <br /> /Jr /N��d z4u'k , ac 3S�I Ini <br /> SY��j <br />