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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page of <br /> Bureau of Ategrated 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 uQ I_I l <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. p cel I.D.# <br /> 07 Ol l <br /> APPLICANT INFORMATION - Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Le2 0 <br /> 1 <br /> Property Owner Property Location <br /> KART p5`(g Govt.Lot 1/4 flr�1/4,s 7 T 4 ,N,R E(or\ <br /> Property Owner's Mailing Ad ess Lot# Block# Subd.Name or CSM# V. <br /> 2 5 F_ vgppw Ri vER R D. l Z v�S1 <br /> City Sthte Zip Code Phone Number ❑ City ❑ village Town Nearest Road <br /> R IBJ 1 $30 c 15��Sb-3 DAKI!a <br /> ll0 New Construction Use: XResidential/Number of bedrooms 2- Addition to existing building <br /> USI Replacement ❑Public or commercial-Describe: e <br /> Code derived daily flow 3�o gpd Recommended design loading rate '� bed,gpd/ft2' a trench,gpd/fl2 <br /> Absorption area required 20 bed,ft2 31S trench,ft2 Maximum design loading rate bed,gpd/fi •$ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) q5-+ ft(as referred to site plan benchmark) <br /> Additional design/site considerations.�n `r <br /> Parent material 6__f c IAL TSI�T Flood plain elevation,if applicable NA ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U Unsuitable for system ZS ❑ U VS ❑ u Vs ❑ U I MS ❑ U ❑S Mu <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell ou.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed Trench <br /> � � b-4 ,S R 2 �'-�— MS 5 M.1 S c.o • '1 .`3 <br /> Ground 3 5 7'stle 4 ( S Sr,, NI) ra .7 . <br /> R - ft <br /> Depth to <br /> limiting <br /> I t <br /> � in. <br /> Remarks: <br /> Boring# <br /> Zco -7 _S <br /> M t g <br /> Ground <br /> ev. , <br /> 1� <br /> Depth to <br /> limiting <br /> f1QtQr <br /> in. Remarks: <br /> ST Name (Please Print) Signature Telephone No. <br /> f,101ARQ �OP9*J5 IIS - 966- 4K7 <br /> Addr ss��160 �� WE I . <br /> Dat` -� CST ZS S <br />