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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 a W x 11 inches in size. Plan must County <br /> Include,but not limited to: vertical and horizontal reference point(BM) direction and R <br /> fjor <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. P el I.D.# <br /> 1,00 <br /> APPLICANT INFORMATION-Please print allInfo►mation. RevZ d y a� Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> d- <br /> Prop"/lOwner ) Property Location <br /> C.LI W OPD A LLA C.E GovL Lot $ 1/4 1/4,S '7 T 4 N,R is E(o6 <br /> Property Owner's Mailing Address Lot# Block* Subd.Name or CSM# <br /> ZOOMS 5WF- E 1Zo- VQL- 4 F 44 <br /> City State Zip Code Phone NumberRoad❑ City ❑ village Town Nearest R <br /> A45UJZ W( o 1115 )$067584 c X 6 o <br /> ❑ New Construction Use: 91 Residential/Number of bedrooms Z Addition to existing building <br /> 14 Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loakting rate •7 bed,gpolft2L_trerich,gpW <br /> Absorption area required _bad,ft2 p=/ trench,ft2 Maximum design loading rate •7 bed,gpd/(tz— trench.gpd/ft2 <br /> Recommended infiltration surface elevation(s) 110.2 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material IQLAC 8 L SKI Or Flood plain elevation,if applicable NA ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure I AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system P9 S ❑ U 14S O u ®S ❑ U WS ❑ u I PS ❑ u ❑s u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDtO <br /> 13 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench <br /> t D-1 mv-Fr As 2vF I 8 <br /> Ground -.7 g <br /> vo� ; <br /> Depth to <br /> limiting <br /> for <br /> Remarks: <br /> Boring# <br /> -$ llsw 3 . 25 <br /> ZS (02- 6 (s 7 9 <br /> Ground <br /> ev. ft <br /> Depth to - <br /> limiting <br /> >&–in. Remarks: HALL AuCQK,j30Qtn1G <br /> CST Name (Please Print) Signature Telephone No. <br /> ;Fit-HAgj:;P Ns �,� /� 715- $4,6- +157 <br /> Address Date CST Number <br /> 2-7 74. o 1503TM IWl. q3 3- I b- 8 3(P70 <br />