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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Page of <br /> Division f Integrated <br /> and Buildings in accordance with Comm 83.09, . f���I A L <br /> Burdau of Integrated Services V <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 h e <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> 03), S 17 d 3 /00 <br /> APPLICANT INFORMATION- Please print all information. Reviewed by Date OO <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). <br /> Property Owner Property Location <br /> DO Ph e 105 Govt.Lot IV /4 5 W1/4,S 17T 4/ ,N,R 1 5'E(or N5 <br /> Property Owner's Mailing Address Lot# Block# I Subd.Name or CSM# <br /> 36161 7;-bor- Glc, Or. d CSM 1/ - 7P. d, k5✓ <br /> City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road <br /> 01+4`11CA11W_ 1 ,5-Y6`30 ( ) 1 s 61 T0.5 r LI r <br /> ❑ New Construction Use: ❑Residential/Number of bedrooms Addition to existing building <br /> JK Replacement [--]Public or commercial-Describe: <br /> Code derived daily Now �{r0 gpd Recommended design loading rate 7 bed,gpd/ft2 • 8 trench,gpd/f12 <br /> Absorption area required bed,n2 S`63 trench,ft2 Maximum design loading rate • 7 bed,gpd/ft2 • trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) _--n(as referred to site plan benchmark) <br /> Additional design/site considerations /� <br /> Parent material 4F/ae- "a-1 Oki-&' Flood plain elevation,if applicable ft <br /> s = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in ill Holding Tank <br /> U = Unsuitable for system fg1 S ❑ U ❑s ® u ❑ s 2 u ❑s Com] u ❑s Nu ❑s o 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 /> 13 -I1- 7rR 15 C JL� -7 <br /> /J.-3S -7 - <br /> /J.-3s- <br /> , <br /> 0 <br /> Ground 3 _7,- -7.s 72 G v-f S ©S c9 tyt 5 7 <br /> elev. <br /> 2(-n. <br /> Depth to <br /> limiting <br /> fa r <br /> Remarks: <br /> Boring# S 3 — /� O S9 rvl 1 G S a . -7: <br /> 48 7-fM % --- v„S 0-so 9 S r f > ; 191 <br /> 3 u��r �,S r� � 06S �► l C7 5 , 7 <br /> Ground <br /> MY. n. <br /> Depth to <br /> limiting <br /> factor <br /> ?.Zin. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> J ofme 3 7/-5-- — y/S" <br /> Address Date CST Number <br /> 0 A�w 3�2 b —o-q 734aL <br />