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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 Coun <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 /> ®/f( 91x5 �S u� v <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)). <br /> Property Owner Property Location v / <br /> Te1%r -To`j)s, Govt.Lot 1/4 1/4,S3 T,7? ,N,R /G' E(or)® <br /> Property Owner'e Mailing Address Lot# Block# Subd.Naw&ePGW# <br /> L e � .vu/ <br /> City ` State Zip Code Phone Number <br /> ❑ City ❑ Village PT Town Nearest Road <br /> ❑ New Construction Use: (Residential/Number of bedrooms Addition to existing building <br /> P<Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 201> gpd Recommended design loading rate_LZbed,gpd/ft2 G trench,gpd/ft2 <br /> Absorption area required ya 9 bed,ft2 3757 rench,ft2 Maximum design loading rate 7 bed,gpd/ft24? trench,gpd/ft <br /> Recommended infiltration surface elevation(s) 577 It(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material G/Ae'rs}/ dPAf - Flood plain elevation,if applicable /LJJ'�ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U Unsuitable for systeml 9S ❑ U Ns ❑ U LAS ❑ U I KS ❑ U Ks ❑ U ❑ S 9U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring Texture Consistence Boundary Roots <br /> :--_--- in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> 0'6 7,syR .do <br /> 2 7,5 ya i �s1^50 � ,� s1,_0 <br /> Ground 7 s f# 7'$' S p V/-c6 '2 <br /> elev. <br /> Depth to <br /> limiting <br /> facto <br /> yin. <br /> Remarks: <br /> Boring # <br /> ,S ;;� %r GS J4ccz <br /> pZ 2 1 <br /> Ground / 'lp 7i 57 2� 02Fi �15 <br /> elev. <br /> Mft. <br /> Depth to <br /> limiting <br /> factor <br /> �1Y_in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br /> lam► �'i s�,^ c r.� eJ.T- 5-V P 7 2- 6/_2 -�9� �s�:3 <br />