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Wisconsin Department of Gommerce 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 /3ctr h -P— tt <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> old,- 0 O o0 <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Date J' <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner //// // / Property Location / <br /> l/!fX C rf �1 Govt.Lot 1/4 1/4,S r T 4/0 ,N,R `� E(or)o <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSMM# <br /> D d —Sb,P /St✓C A1,0 //_4, S,40-f/Yd /--,,H, 4l. ILd u,as <br /> City State Zip Code Phone Number ❑ City ❑ Village K Town Nearest Road <br /> j/ n o at h jA7A1 J-J-9 VJ (Gl X )rJ73—18701j L,1&e_1cseSlpilf�cl Fel wrr <br /> ® New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 306 gpd Recommended design loading rate 5 bed,gpd/ft2 - b trench,gpd/ft2 <br /> Absorption area required tial bed,ft2trench,ft2 Maximum design loading rate -7 bed,gpd/fF,_g trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/site considerations ` <br /> Parent material Flood plain elevation,if applicable NA ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure I AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ®s ❑ u NE ❑ u 1Zs ❑ u 121S ❑ u (gn S ❑ U ❑s MU <br /> SOIL DESCRIPTION REPORT <br /> Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> a-`t rY <br /> Ground 3 <br /> elev. <br /> S"11`40 F5 <br /> Depth to <br /> limiting <br /> factor <br /> 7g0 in. <br /> Remarks: <br /> Boring# <br /> 1 d-LF 7_s'YR 3/� .S vt1 ! GS 3Gb •'� ; <br /> y-33 7. 1? 4/4m.s r>7 r' CSa <br /> 5 1v(✓ <br /> Ground <br /> e ev <br /> 5 / <br /> Depth to <br /> limiting Lt 1 <br /> factor <br /> 7 67 in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> LhpemS- d .i 40 7i5=k6-47— W.P <br /> Address Date CST Number <br /> A776 a Hm. w f -1A- <br />