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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 County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and u <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.If <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 /> �{{(J Govt.Lot 1/4 1/4,S T L�p ,N,R E(dQ• s <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> ""7 - taB-I �0491ZUWP ADo To V.V- <br /> City State Zip Code Phone Number(��I ) El City ❑ Village � Town Nearest Road <br /> �/I� <br /> aA ?R. W <br /> New Construction Use: Residential/Number of bedrooms 3 Addition to existing building <br /> ReplacementJ(� ❑Public or commercial-Describe: <br /> Code derived daily flow 46) gpd c,r� Recommended design loading rate A bed,gpd/ft2 .� trench,gpd/ft2 <br /> Absorption area required. ?> bed,ft t/ynch,ft2 Maximum design loading rate •� bed,,gpd/ft2 <br /> Recommended infiltration surface elevation(s)q3.4 1 •$ trench,gpd/ft2 <br /> ��2:s ft(as referred to site plan benchmark) <br /> Additional designtsitQ considerations <br /> Parent material AIACOL 11Fr Flood plain elevation,if applicable 0A ft' <br /> S = Suitable for system Conventional �M,I,ound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system % S ❑ U U�Y S ❑ U I %S ❑ U ilds ❑ U S ❑ U ❑ S '"o U <br /> SOIL DESCRIPTION REPORT - <br /> Boring Texture# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> I I 0.1 2 �— 15 s ( -I .S <br /> Z -7, 4 �_ �S PAI S ( co <br /> Ground 3 s Q 6' O�- S W S �M1 I (• .'1 .g <br /> Qelev. <br /> Depth to <br /> limiting f <br /> factor <br /> in. <br /> Remarks: <br /> Boring# <br /> .7 .$ <br /> Ground <br /> ev. <br /> ft. <br /> 3, a <br /> Depth to <br /> limiting a <br /> factor <br /> Z <br /> 7 ;n. Remarks: fit <br /> CST Name (Please Print) Signet ur Telephone No. <br /> «t,ow l�oPlunlS 1�-�(ob- x}15? <br /> Add ss Date CST Number <br /> 3S 40s VR �,,>>- 3 a- I2 -9q2,ZSSSt <br />