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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Qivision 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 ander <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. parcel I.D.# <br /> ao 3,0 5�d o 2 <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)). Af <br /> 8 9� <br /> Property Owner i Property Location / <br /> C� �/ s Govt.Lot 1/4 1/4,S T�D ,N,R E(or <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> City / / t l r State Zip Code Phone Number Nearest Road <br /> l�h ro of N SSI1� (61a a (94 <br /> ) 9 77 ❑ city ❑ Viylla Town <br /> New Construction Use: Residential/Number of bedrooms 2– Addition to existing building � <br /> Replacement N Public or commercial-Describe: I <br /> Code derived daily flowlyao gpd Recommended design loading rate_,7 bed,gpd/ft2—ei—rtrench,gpd/ft2 <br /> Absorption area required V-17- bed,ft2_G�trench,ft2 Maximum design loading rate bed,gpd/ft2 ,Y_trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material G�C l /T �' Flood plain elevation,if applicable ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade ,S�y/stem in Fill Holding Tank <br /> U = Unsuitable for system S ❑ U I S ❑ U ;Ks El 14S ❑ �F U 9s El U EJTa <br /> S �-u <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 <br /> Bed Trench <br /> ZAddE <br /> a <br /> 7,5-71flS f-cH ,8 <br /> Ground 3 �J� �.�40 , <br /> elev.� <br /> Depth to <br /> limiting <br /> factor <br /> >7 in. <br /> Remarks: <br /> Boring # <br /> C-S 05o17 0 <br /> Ground <br /> elev. <br /> 9ft. a <br /> Depth to <br /> limiting <br /> factor <br /> ,_772,in. Remarks: <br /> CST Name (Please Pri ` Signature Telephone No. <br /> LJ,4,'.4� vSha�•�i �J -- �9�,7 P� <br /> Address <br /> q t Date CST Number <br />