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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safaty 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. Pa el I.D.# <br /> APPLICANT INFORMATION- Please print all information. Reviewed by / Date G <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location 11 <br /> Govt.Lot 1/4 1/4,S T h10 N,R Itp E(or - . <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 38 iace St'. I�•E. 2,2. tx <br /> Ci State Zip Code Phone Number ttcd,r Nearest Road <br /> ❑ City ❑ Village US6 Town <br /> t SS ( ) >Jn1lG46 ART&IR5 Cr <br /> LI New Construction Use: Residential/Number of bedrooms Z Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 00 gpd Recommended design loading rate bed,gpd/ft2 .8 trench,gpd/ft2 <br /> Absorption area required_401 bed,ft2 376' trench,ft2 Maximum design loading rate .7 bed,gpd/n2 .0b trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) U.1 It(as referred to site plan benchmark) <br /> Additional design/sit/e�considerations <br /> Parent material�l _L GIAL ��� Flood plain elevation,if applicable _rft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S U X S ❑ U *Vr'S ❑ U V-q ❑ U JX S ❑ U ❑S 21 U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring Texture Consistence Boundary Roots PD/ <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> 7•S �' MS bs 1 s <br /> Ground <br /> elev. <br /> ft. <br /> Depth to <br /> limiting <br /> f , <br /> ; or in. <br /> Remarks: <br /> Boring# <br /> - 0.5 S R 3 <br /> -7.964K Al v MS :7 $ <br /> n�:,, <br /> Ground <br /> n. <br /> Depth to <br /> limiting <br /> faf1k r ,,�` <br /> in. Remarks: AWQ AufFr150t¢� <br /> CST Name (Please Print) Signature Telephone No. <br /> _Z,/YAJe12 d 4S <br /> Ad ess Date CST Number <br /> gn WEas'W t• 54843 -5-IS 22.E <br />