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WisconsI6 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 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 t// i j e_ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 03 yav <br /> APPLICANT INFORMATION- Please print all information. Reviewed byDate <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 61a 45r� <br /> Property Owner Property Location <br /> Govt.Lot 1/4 1/4,S T YD ,N,R Z E(orj J� <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> C? / r(J <br /> City State Zip Code Phone Number Nearest Road <br /> ❑ City Village ®/- Town / <br /> ❑ New 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/ft2_p_trench,gpd/ft2 <br /> Absorption area required 5/3 bed,n2 S6 j trench,n2 Maximum design loading rate bed,gpd/ft2 g trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) �y S� n(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> r � <br /> Parent material 74 7— Flood plain elevation,if applicable n <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-GradeSystem in Fill Holding Tank <br /> U = Unsuitable for system S ❑ U S ❑ U MS El 19S 1-1U S ❑ U ❑ S E�U <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> 9 Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# <br /> 71e 01 <br /> / 'CP a <br /> WE <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> 78o in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br />