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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page I of 3 <br /> Bureau of Integrated services in accordance with Comm 83.09, Ws. 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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. `r n` <br /> Parcel I.D.# <br /> APPLICANT INFORMATION- Please print all information. °-2- - 3 1 C 3 -C3 <br /> Personal information you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)). Reviewed by Date <br /> Property Owner <br /> Property Locatio <br /> �f2L— ��1�vr1 Govt.Lot t <br /> F114 nE1/4,S 43 T ?70 ,N,R (� E(or t <br /> Property Owner's Mailing Address Lot# Block# Su.-Name or CSM# <br /> /r`r a0 s o71c41 ab,e(/ <br /> +8&a'IZta.nx,,� �r9� roV �.5 �5 <br /> City State Zip Code Phone Number ❑ City ❑ village ® Town Nearest Road <br /> oorlea- ,J. 54$O I ( ) , !^7 <br /> �F}r n boL. �oA r <br /> ❑New Construction Use: gResidential/Number of bedrooms Z Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow .300 gpd Recommended design loading rate . 7 bed,gpd/ft2 I tt? trench,gpd/f12 <br /> Absorption area required 2-1 bed,ft2 376- t/rench,ft2 CMaximum design loading rate , 'I bed,gpd/ft2 8 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) KG,f7/ 7,34_l ft(as referred to site plan benchmark) <br /> Additional design/site considerations A &M G/ o r n fL' 'Z� <br /> Parent material /F1Cf Rc Flood plain elevation,if applicableft <br /> i <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-GradeSystem in Fill Holding Tank <br /> U Unsuitable for system <br /> AKS El u ❑s 0<u ❑ s u ❑s u ❑S g u ❑ S E;a't I <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 /> Bed , Trench <br /> 5" zSMK 3/z 0mcsne <br /> Z S- 7.51 R`t atcM 1 c b it rn r <br /> Ground <br /> Q_ 15-12— 7.5'Y(Z4 a+iG 1x,_ <br /> Depth to <br /> limiting <br /> factor <br /> lL in. <br /> Remarks: <br /> Boring# r <br /> T.SYR 3j2- <br /> W, manE 5 M1 Cd' 3J <br /> •7 <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor 1� <br /> ft in. Remarks: <br /> CST Name (Please Print) MITS SUIL I ES I IN63 Signat Telephone No. <br /> N6228 Coun Line Rd. , <br /> Address (715) 635-74VVI $2 Date CST Number <br />