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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 B 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. parcel I.D.# <br /> 6,11- y!aa-o_3 . <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)). /V <br /> Property Owner Property Location " <br /> E Govt.Lot 5 1/4 1/4,S22T4 ,N,R 4 E(or <br /> Property ner's Mailing Ad ress Lot# Block# Subd.Name or CSM# <br /> 204 V. EST %+3 Vo4 4, P. 282.283 <br /> City State Zip Code Phone Number ❑ City ❑ Village IN Town Nearest Road <br /> W4MVI A41 .SCo <br /> ANew Construction Use: ❑Residential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate bed,gpd/f <br /> .7 t2 .$ trench,gpd/ft2 <br /> Absorption area required bed,ft' .5`3 trench,ft2 Maximum design loading rate -07 bed,gpd/ft2 • $ trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) _ s.i ft(as referred to site plan benchmark) <br /> Additional design/site l7�te^..co,^nsiderations A-T 5l ITE '"jE7f1iy Al- 9AKU115 Z nATE ,'ff <br /> Parent material AL tip DAIf r Flood plain elevation,if applicable NA R <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system I ® s ❑ u 9s ❑ u Ns ❑ u tQ S ❑ U 9 s ❑ u ❑ S _rA u <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 /> Y <br /> r ,. <br /> -7 . g <br /> 2 7- 4 6 .--- Ms os A4 ( .— �'co .7 4 <br /> Ground <br /> ev ft , <br /> Depth to <br /> limiting <br /> ctor <br /> 0 in. <br /> Remarks: <br /> Boring# 0•S 7' R Z �" s t 2 - 7 <br /> 2 2 y- 7• 4[b '' MS as lu 1 .7 <br /> Ground <br /> Depth to <br /> limiting <br /> t&Vr <br /> > in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> ltmwv ?lS- 866- 4192 <br /> Addr ss2'7 7&0 w � Dat�� — CST Numb r <br /> � <br />