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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Safqty and Buildings Page of .3 <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 '�3 -T- <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> d 71� - 0 0?_ <br /> APPLICANT INFORMATION- Please print all information. Review <br /> te <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). fl _ Da <br /> Propertv Owner Property Location (J� <br /> a-✓bw✓w ci t`U 5 O Govt.Lots „7 � j 14- Tg,S � T AI j,N,R /5 *or)w <br /> Property Owner's Mailing Address Lot# Biock# 3nb�rNeme or CSM# se.net r nem <br /> 7/0 :5_u�_b tSPYwk.). 2 <br /> City / State Zip Code Phone Number ❑ City El Village Town Nearest Road <br /> New Construction Use: LSI Residential/Number of bedrooms <br /> ❑ Replacement --� Addition to existing building <br /> P ❑Public or commercial-Describe: <br /> Code derived daily flow 450 gpd Recommended design loading rate •7 bed,gpd/ft2 - 3 trench,gpd/ft2 <br /> Absorption area required _bed,ft2 5&,3 trench,ft2 Maximum design loading rate=7 bed,gpd* e �3 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) r'y �+ 95 rf��9'!�j 8a-3-5;�(,Ji `51t'(as referred to site plan benchmark) <br /> Additional design/site considerations Q7 a,0 .SYSTEM E4E,s7,ox)S t2dOwnE A(-)IimbN rr 614AI4g&/_S , or S/fie k"Tox) <br /> Parent material C1^L 1 RIFT Flood plain elevation,if applicable N/A ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System <br /> rin� r <br /> Fill Holding Tank <br /> ' <br /> U = Unsuitable for system ❑ U ❑S �1 Ot ❑ U ❑S CSU El LSI U ❑ S tJ v <br /> SOIL DESCRIPTION REPORT <br /> Boling# Hotizon Depth Dominant Color Mottles Structure ry GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed , Trench <br /> r A o-4 7.5 YR 3/z 45 I Fsw mV�✓ G 3F .7 . e <br /> d 3� 75 Y `//¢ aZ M 6bx, mV FV c' .7 ; >r <br /> Ground 3 < R �l� 1_FS ) m sb/< M V f Y- 5 <br /> elev. 2F - 6 : <br /> , <br /> 99..Vrf. C_ 4045 7 5 YR 5121 OSCI M -e — w, / = •7 .8 <br /> �/ BANOS 5 y/z y/� zT <br /> Depth to t/Fr — — � 7 - <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> A 0-5 ?5 YR 3/z v- LS 1 FSbK )rytVF✓ C 3 F ,7 ,g <br /> 2iz> 5-39 75 A 'W< my h r as ,2,r,2G .7 <br /> 4K MVFr a-5 am 1�_ .5 .� <br /> Ground 3L 4-771 7.5 A, 000 Cr .5 Z . -7 �8 <br /> elev. / <br /> U/ 'd's J �/T �J �`� 1N�F✓ lm I F .7 <br /> Depth to 77-/ 75A 77- S Oso )hVFr - 1 F �*T <br /> limitingal� grJ05 5 Y9 // c� J J I N U — — 7 ; <br /> factor <br /> .;ICO Remarks: <br /> CST a (Please Print)/� Signature Telephone No. <br /> RAI 0NP-0 <br /> Address Date CST Number <br /> S�F�9S 1�27'27 go T <br />