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WP sconsin 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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. <br /> 1 05 120 <br /> APPLICANT INFORMATIQN- Please print all information. Reviewed by Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> Govt.Lott„ 1/4 1/4,S 35 T q .,N,R �(j E or(Y <br /> Prop rty Owner's Mailin Address Lot# Block# Subd.Narne or CSM# <br /> % qv. 3 0 1 <br /> C' State zip Code Phone Number ❑ City ❑ Vi lage Town Nearest Road <br /> O New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> }loyl Replacement �j� Public or commercial-Describe: A <br /> Code derived daily flow 4:56 gpd Recommended design loading rate 7 bed,gpd/ft2 • D trench,gpd/ft2 <br /> Absorption area required_ka .bed,ft2.__trench,ft2 Maximum design loading rate • 7 bed,gpd/fI2 - $ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s)ROW ON D ft(as referred to site plan benchmark) <br /> Additional design/site considerations ARL 1pPERT Ott- MOut"> p. u RET <br /> Parent material GLACIAL yRtFT Flood plain at if applicable ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure I AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system EISJNU S ❑ U ❑S %U ❑S 0 U ❑S RU S ❑ U <br /> SOIL DESCRIPTION REPORT <br /> Boring# 45V <br /> minant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 <br /> Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. iMtrGround ¢ C f S GO • 6 <br /> elev. <br /> Depth to <br /> limiting <br /> Tin.Tin. <br /> Remarks: <br /> Boring # 5 7•S .� Z /�-_� t/�r CS ✓ 7 •$ <br /> t .7 <br /> �✓fi <br /> 7-Al <br /> �— ; . � <br /> Ground 7S r f N <br /> Depth to <br /> limiting <br /> f or <br /> in. Remarks: <br /> CST Name (Please Print) Si nature Telephone No. <br /> t4AAg1 p A0PXljJs S- &96 S7 <br /> ber <br /> Ad ress Date <br /> CST ur Z>sg) <br /> 02-1 <br /> a144v3S ESst 1a1• $ 2 , h <br />