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Wisconsin Department of Commerce SOIL AND SITE EVALUATIV (` I I A L <br /> Division orSafety and Buildings Page of <br /> BLreWis.of Integrated Services in accordance with Comm 83.09, s. A <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. parcel I.D.# <br /> o -?3 0 / X00 <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Data <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> L 0 U/ C Govt.Lot 1/4 1/4,Sa T {/� ,N,R /j E(or)(0 <br /> Property Owners Mailing Address Lot# Block# Subd.Name or CSM# <br /> City State Zip Code Phone Number ❑ City ❑ Village a Town NeareORoad <br /> s1,� e ----I ( )-7YSL j45-0 sp.-v I k///"/fir <br /> ,New Construction Use: P4Qesidenfial/Number of bedrooms Addition to existing building <br /> ❑ Replacement Public or commercial-Describe: <br /> Code derived daily flow �SU gpd Recommended design loading rate �3b /fl2 <br /> gpd 4; trench,gpd/ft2 <br /> Absorption area required 9Zf10 bed,n2 trench,n2 Maximum design loading rate / bed,gpd/ft2___4!�__trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 97 n(as referred to site plan benchmark) <br /> Additional design/site considerations ` <br /> Parent materia) 9//4-C 'Ll f 0//_ i ile-1— Flood plain elevation,if applicable /L/ ft <br /> S = Suitable for system I <br /> Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for systeml ❑s ❑ u ❑s ❑ u ❑s ❑ u ❑s Elu ❑s ❑ u Els F-1u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fl2 <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench <br /> ✓1��- 3,40 . 6 <br /> Ground <br /> ev. n <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# , <br /> jr <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> 7 in. Remarks: <br /> CST Name (Please Print Signature Telephone No. <br /> tide l�il��ia r-� Chaff 2- <br /> Address <br /> Address r Date CST Number <br /> Ad"4-5-ly s e- S-` I-✓ - - -ori ,-z765" <br />