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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page of <br /> Bureau of Integrated Services in accordance with Comm 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 nn <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and D ct r n <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> pdkd._ 43 s- 0A40p <br /> APPLICANT INFORMATION- Please print aii information. Reviewed by Date <br /> Personal informatbn you provide may be used for secondary purposes(Privacy Law,s.15.04(l)(m)). �.��� (� <br /> Property Owner Property Location 14S <br /> Govt.Lot AlUA14 N&q/4,S AS– T 14b ,N,R /fp E(or)AD <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> P.O. 134 / 3/ /0r*cre3 <br /> City State Zip Code Phone Number ❑ City ❑ village [E] Town Nearest Road <br /> OR 11 ��v Wl J'9-If'3 V 31�£f Dw/c/a !?ush /l <br /> [�New Construction Use: Residential/Number of bedrooms 3 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow y r0 gpd Recommended design loading rate bed,gpd/ft2 r-(-trench,gpd/ft2 <br /> Absorption area required bed,ft2 4po trench,ft Maximum design loading rate bed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) qs 1/VGt /Y/s,, �ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material ee lac C i A 1 0 v i i<� Flood plain elevation,if applicable A/Z n <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ®s ❑ u ❑s ® u ❑s LOU ❑S ® U ❑s ® u ❑ s k 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 /> 1 G-S 7-X14 j 0sy rn 1 CS 3C0 <br /> t $ I S 7,SYR "Iv -r f's O S 5 m 1 9 5 <br /> Gro <br /> und 3 /$-5k 7,S``f/{ %f> __ tr f o s 5 v>7 1 9 5 <br /> 4f�n. _6 �,sfR y/ C,.�j s-y � ¢ s OS5 t' c S --- • � <br /> Depth to <br /> limiting <br /> factor <br /> 5G in. <br /> Remarks: <br /> Boring# <br /> o-s' 7S-r R — /S 0.55 I L3 34p �. <br /> El J_ S=}I '7•s-YR `'I4 )eJ 0S,j r� 9 S 3rh ,S' <br /> 3 �i-5 7,S-Y4 y/ ._ zL� O,SS <br /> Ground -P 71 -YR y Z _rVd �S 015 r*, I C 5 • S <br /> elev. <br /> fir <br /> —7ft. <br /> Depth to <br /> limiting <br /> factor <br /> Ss' in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> J � S 7/f k�6-el-1-s-7 <br /> Address 01 Date CST Number <br /> �7-76,1 -734/ 0— <br />