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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Divisioh of Safety and Buildings Page of- <br /> Burbau 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 Q <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and 8 V r n G-yI+ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> O a Q - 05 -oa - "D <br /> APPLICANT INFORMATION - Please print all information. Reviewed by L& 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 /> 2 Govt.Lot S 1/4 1/4,S 5 T yp ,N,R (� E(or)(@ <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> a 9 b I M a r r o c- ; rcrl <br /> City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road <br /> S'i'r r- I MN SO ((051 ) Y30-6)0 a <br /> tr. ;ca ; o.. o o E. <br /> New Construction Use: ®Residential/Number of bedrooms Addition to existing building ;/ <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 300 gpd Recommended design loading rate S bed,gpd/fL 16 trench,gpd/ft2 <br /> Absorption area required bed,ft2 trench,ft 2 Maximum design loading rate . ,5 bed,gpd/ftz.trench,gpd/ft2 <br /> Q CNY �Q•tel t ft(as referred to site plan benchmark) <br /> infiltration surface elevations) <br /> Additional design/site considerations <br /> Parent material Flood plain elevation,if applicable ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system as ❑ U � S ❑ U �S E-1U � S El ❑ S © U ❑ S W U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> 9 in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots Bed Trench <br /> -9 1 Dy 4-A. OF IL me r- <br /> -7. f <br /> .SY Y/ SL- AFSb V. YNA ry, CkA,3 ahl . S Av <br /> Ground 3 14-yo 1•S`fA yl`l FS I Fsbv o,F� r,w I F .6 A01 <br /> 9�ele,,v�. <br /> Lk ft. y . , -7.5%(OQ F5 0-6A <br /> Depth to <br /> limiting <br /> factor <br /> OQin. <br /> Remarks: <br /> Boring# <br /> tr <br /> Ground <br /> elev. <br /> ft. , <br /> Depth to eVNASMMn4 0 1.4 <br /> ' <br /> limiting <br /> factor <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> r 115-aq 2 -35$8 <br /> Address Date CST Number <br /> S +kd c e IJ'o1 -2 all `I <br /> S YDa V <br />