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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division df 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 /> inctude,but not limited to: vertical and horizontal reference point(BM),direction and 9W/.A.) �1/ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.N <br /> © aqs7 d fid© <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 /> Property Owner Property Location <br /> to 42 ki 6.41 Govt.Lot s•C_7 1/4,5ej 1/4,Sf T y0 ,N,R J E(or)(0 <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 35'0 Y /3 ?t;� <br /> City State Zip Code Phone NumberCity EK Town Nearest Road <br /> ❑ ❑ <br /> n.�0 u e jr /V V 5] j' (6/a >S76-/SLq S'� Villa e o L oN L K- <br /> New Construction Use: X.Flesidential/Number of bedrooms Addition to existing building —' <br /> ❑ Replacement ❑Public or commercial-Describe: — 77 0 <br /> Code derived daily flow 41-5-0 gpd Recommended design loading rate gybed,gpd/ft2 - a trench,gpd/ft2 <br /> Absorption area required_p _—bed,ft ��3 trench,ft 2 Maximum design loading rate bed, d/f12 <br /> ry g g �� gp _trench,gpd/ft2 <br /> Recommended infiltration surface elevations) 95 O ft(as referred to site plan benchmark) <br /> Additional design/site considerations `— <br /> Parent material 62 i4 /�I �/�i�f' Flood plain elevation,if applicable ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ❑5tS U 9s El � ❑ Xs U U I ❑ U 2�s ❑ U ❑ S 9 U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> I °- 7 '5' , <br /> s J-sriP <br /> `� , 1 <br /> Ground 3 / -g �--- �jj — 7 <br /> jilev.. <br /> ZG.C_ft• <br /> Depth to <br /> limiting <br /> factor <br /> 77in. <br /> Remarks: <br /> Boring # <br /> �, c5 <-O <br /> -re , 7 <br /> 3 ;;0V7-S S _,,_2 <br /> - <br /> Ground <br /> elev. <br /> QZ Ln. <br /> Depth to <br /> limiting <br /> factor <br /> ? in. Remarks: <br /> CST Name (Please Prin Signature Telephone No. <br /> GJ,grl� v to �✓ � drYp 7.-7C6 <br /> Add Date CST Number <br />