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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> ,Division of Safety and Buildings Page_L 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 Count <br /> Include,but not limited to: vertical and horizontal reference point(BM),direction and �t <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> Parcel I.D.# ©Q I <br /> APPLICANT INFORMATION- Please print all information. Reviewed by f////��� / Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). /.j c, ,f <br /> [Property <br /> rop Own r Property Location [[(( !/" <br /> h C Govt.Lot I� 1/4 5�1/4,S T N,R �/{ WW)W <br /> Owner's M Ming Ad ess Lot#----FB Subd.Name or CSM# <br /> t <br /> City State Zip Code Phone Number <br /> ❑ City ❑ Village [$ Town Nearest Road <br /> LL 4- 1 06 c5-548?i 1 (?/ ) W1 0f A I Ga <br /> 19 New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 50 gpd Recommended design loading rate Ak7bed,gpd/ft2_A�_trench,gpd/ft2 <br /> Absorption area required pf% bed,ft2trench,ft2 <br /> Q Mgaxirmupm d s�rgyn.loading rate-* bed,gpd/ft21_�trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s),B 1�/TJ 2, — b/r� ✓fbr/✓�7Y (areferred to site plan hmark) C <br /> Additional design/site considerations <br /> r <br /> Parent material Flood plain elevation,if applicable <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 JX, U S ❑ U I ❑S I U ❑s fVU ❑S P(U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> i• Bed , Trench <br /> ioj 7 9W �✓5 <br /> " r17- <br /> 7,5 <br /> Ground og- 7 y <br /> Oele ` <br /> Depth to <br /> limiting <br /> facto <br /> in. <br /> Remarks: <br /> Boring# <br /> / 7 <br /> o7 ot <br /> Ground C <br /> ft. 06 r <br /> Depth to <br /> limiting <br /> fac or <br /> n. Remarks: <br /> CST Name (Please Print) ITZ, INC. Signa Telephone No. <br /> Septic Systems ' <br /> MPRSze <br /> Address P.O. BOX 160 Date CST Number <br /> SHELL LAKE, WI 54871 7 <br />