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Wisconein Department of Commerce SOIL AND SITE EVALUATION Page of <br /> Division of Safety and Buildings <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 Q aoaN- Tr <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <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)). �p2 <br /> Property Owner Property Location <br /> ![ �C Govt.Lot 1/4 1/4,S Tt3 N,R 25(or)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> oS' 8J, q1 JkJ PbeA r l'oN OR us!- f �' <br /> City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road 14,48r <br /> Ak-RflIMAC i 5-J,6 ((co$)6yj-S <br /> [e ANew Construction Use: Ili Residential/Number of bedrooms 3 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate 1Zbed,gpd/ft_LP trench,gpd/142 <br /> Absorption area required _bed,ft26 / trench,ft2 Maximum design loading rate—4-7—bed,gpd/ft2_4__E_trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) g�.(a A4 r 96,y n(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material 6 LA6i AL 1)/Z/h-r 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 U ❑S u ❑ s U'0' ❑ s 9?t ❑s U ❑S [I1 <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots Bed ,Trench <br /> �z. <br /> .,� 0-1- 7,6-Yh .3/ S 7r CS Go YXb <br /> Ground J — <br /> elev. <br /> /eft• <br /> Depth to <br /> limiting <br /> factor <br /> 7t6 -in. <br /> Remarks: <br /> Boring# <br /> =s� <br /> I 0-id 7,s Via- -- s Cs 3 ce, <br /> s <br /> A 7 <br /> l ^ <br /> Ground <br /> elev. <br /> Jcot�ft. , <br /> Depth to <br /> limiting <br /> factor <br /> 7in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> C46c 'S" t2 /5- <br /> Address Date CST Number <br />