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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 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 N .41 e— <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> D/Y 0 Dov <br /> APPLICANT INFORMATION - Please print all information. Reviewed by Date qq <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 16 !� <br /> Property OwnerProperty Location <br /> "Cl, <br /> of rtS Govt.Lot Y 1/4 1/4,S/ T,38' ,N,R/S' E(ore) <br /> Propeely ner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 3 Sao /aNe oQJ <br /> City State Zip Code Phone Number ❑ City g Town Nearest Road <br /> ❑ Village <br /> W-r I 5-y8 ( 17AR, <br /> ❑ New Construction Use: E&esidential/Number of bedrooms Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 3a D gpd Recommended design loading rate 7 bed,gpd/ft2 e 8 trench,gpd/ft2 <br /> Absorption area required SD bed,ft2 -?sb trench,ft Maximum design loading rate_,eZbed,gpd/ft2�trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) .7/en013 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material 45;;499—;.41 d,^;lee- Flood plain elevation,if applicable,4�.00+ ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system �J S 54 U ;KS ElU ❑ 1�S U ❑ S KU ❑ S KU ❑ S Z,U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots Bed Trench <br /> c2 0kd_3 7.1' �P <br /> Ground <br /> daft. ' <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> J <br /> 7 r R� /S s <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> 47in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br />