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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 81/2 x 11 inches in size. Plan must County <br /> include,but not limited to: vertical and horizontal reference point(BM),direction and 06 4,V,Je-7�' <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 00 <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)). <br /> Prop rty Owner Property Location !✓ F <br /> Govt.Lot / 1/4 114,S13 T 30,N,R/7 E(or)(Z <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> a33 Ise 40e — <br /> City , State Zip Code Phone Number <br /> ❑ City El Village U4 Town Nearest Road <br /> CS-New Construction Use: �Residentia)/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow O J gpd _ Recommended design loading rate i S bed,gpd/ft2 - 6 trench,gpd/ft2 <br /> Absorption area required O a bed,ft2 5 D D trench,ft2 Maximum design loading rate ed,gpd/ft2 0 � trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9s 3 �P�i►ccAt eb/y� ft(as referred to site plan benchmark) <br /> Additional design/site considerations 1 <br /> Parent material G/_mss j tet' l�� Flood plain elevation,if applicable IVA ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system E: U MS ❑ ❑ 2{s <br /> U WS U ❑ U I ZS-r, ❑ U ❑S MU <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 /> � p - . <br /> Ground 0- !I l8� C ;2c%S�y/P71' <br /> elev. <br /> rq-7,//-ft' <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> 02 <br /> g,:. <br /> Ground <br /> 7-17i <br /> T�`ft- <br /> Depth to <br /> limiting <br /> factor <br /> ;?Z—?in. Remarks: <br /> CST Name (Please Print) /Signature Telephone No. / <br /> /fes>✓ 6 O r�7 (s7/GraG¢ 7� b <br /> Address Date CST Number <br /> /36�(.S/t 5: e —2 7-09- Z� 3� <br />