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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> .Division cif 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 /> APPLICANT INFORMATION - Please print all inrormation. Reviewed by / Date <br /> Personal infonhation you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). �" f !"'7 <br /> Prop3 Owner Property Location <br /> Govt.Lot 1/4 1/4,S 24T N,R 11 E(o YV <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> EL 1 V o c,, t6 P 80 <br /> City State Zip Code • Phone Number Nearest Road <br /> El ❑ Village Town <br /> eJ IST to E. SASS <br /> ❑ New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow ASO gpd Recommended design loading rate bed,gpd/ft2 •$ trench,gpd/ft2 <br /> Absorption area required bed,ft2 54%s/� /trench,ft2 Maximum design loading rate •1 bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) �`-t•6 n(as referred to site plan benchmark) <br /> Additional design/site considerations r <br /> Parent material A] AL Flood plain elevation,if applicable SA n <br /> S = Suitable for system Conventional KiMnound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S ❑ U la S ❑ U WS ❑ U 1 19 S ❑ U ®S ❑ U ❑ S DC U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. / Bed Trench <br /> tit <br /> ,ter;••. <br /> .$ <br /> Ground <br /> Depth to <br /> limiting <br /> ctor <br /> ain. <br /> Remarks: <br /> Boring# <br /> 74-11Z z �---- S M 5 <br /> 2 4(0 •S rz (. n� S <br /> 3 C Ms MI I...... <br /> .7 .S <br /> (�Ground <br /> Oft. �J <br /> Depth to <br /> limiting <br /> f <br /> Wrin. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> ICt Aft J�PXJP4 <br /> Address /�Q �� Date CST Number / <br />