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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of,Safety and Buildings jr A e of <br /> . <br /> Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County nn <br /> 'fhclude,but not limited to: vertical and horizontal reference point(BM),direction and J0 hn <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 00L4 - 3110 -or- 4too <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 <br /> L L ced J h n s n Govt.Lot 3 N45 1/4 Ni✓ 1/4,S /d T G( ,N,R E(or <br /> Property Owne s Mailing Address Lot# Block# Subd.Name or CSM# <br /> 3 L16 131<h S>. 4/6 <br /> City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road <br /> Ow 4 nnA IM N 1.4_4-060 1 (5-0 )4Sy-07 (�rc 6/< <a Rd- G <br /> [9 New Construction Use: R]Residential/Number of bedrooms —47 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow3-00 ^'t )•, Recommended design loading rate bed,gpd/ft2 • 0 trench,gpd/ft2 <br /> Absorption area required 1`S 0 If h bled,ft s if"nch,n2 Maximum design loading rate bed,gpd/ft2—.—T—trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 7r g ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material Flood plain elevation,if applicable 7/1 ft <br /> S = Suitable for systemConventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ❑ s 1X U 12 s ❑ u ❑ s 0 u ❑ s 13 U ❑ s ® U ❑ s IRU <br /> SOIL DESCRIPTION REPORT <br /> Boren # 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 /> I o-4 zSrR% /s 0s5 cs 3 .„ 7 .8 <br /> 4-15" <br /> 7,s-)-A 4�4 H1 OS9 vr1 1 G S m 7 . e <br /> Ground ,3 33 7 S'/R 4 6itS� 7 f5 �s9 n�Ei L 5 i v f .S, , 6 <br /> e e�v.. <br /> _Lft. 4t 1313 7,SYf� r C }ej Tf R �� M S O 5clI G 5 7' 8 <br /> Depth to <br /> limiting <br /> factor <br /> min. <br /> Remarks: <br /> Boring # <br /> 7's-m% /S 0 Sq 7 <br /> 4 4-yti -7Sg4 rns 059 f 6.5 01. m , 7 , >� <br /> 4- & 7,s7f'1Yf- Gid/ syR%g L-5 059 Y', <br /> Ground 36 S3 7r St4 �ZI or�/� Yh 5 5 4'1'1 if c , b <br /> e�v <br /> Depth to <br /> limiting <br /> factor <br /> Pin. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> fJ Athes S, (J���lel s S ��s= o 6 - �i5" 7 <br /> Address Date CST Number <br /> Ji-7 6 -5W e_ - fs 3� �- 7 ( -U- <br />