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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 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 F2 uRKk�m <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Pfircell I.D.# <br /> L�L4-S <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)). S <br /> Property Owner Property Location ' ^n <br /> C uE Gmd_W nJW-SIF 4/t C 1/4,S if T` 0 .N,R E(ome <br /> Property Ownees Mailing Address Lot# Block# Subd.Name or CSM# <br /> tt <br /> City State Zip Code Phone Number ❑ City El wage Town Nearest Road <br /> IbLdmCt1P0RO 65n2_ 417- >S6o -" Aki_ cec Ro . <br /> ❑ New Construction Use: Residential/Number of bedrooms Addition to existing building <br /> 0 Replacement N Public or commercial-Describe: <br /> Code derived daily flow 5QQ_gpd Recommended design loading rate S bed,gpd/fi2 - `' trench,gpd* <br /> Absorption area required((_bed,ft2 - OD��tt trench,ft2 Maximum design loading rate_'Y bed,gpd/tt2 ' & trench,gpdHt2 <br /> Recommended infiltration surface elevation(s) 94.0 it(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material Cj nc.i AL�DLIO' Food plain elevation,if applicable NA ft <br /> S = Suitable for system Conventional MoundIn-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system ® S ❑ u M s Elu Q s El WS ❑ u ®s ❑ u ❑s ® 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 /> .s' � -G <br /> 26,7 7.S R 4/4 <br /> �Ground <br /> Depth to <br /> limiting <br /> fa or <br /> ; • <br /> Remarks: <br /> Boring# $ ,6 <br /> 'T <br /> Ground <br /> nelev. <br /> Depth to <br /> i <br /> limiting <br /> f r <br /> in. Remarks: kAall2Q44, tZ $OXII-Jr: <br /> CST Name (Please Print) Signature Telephone No. <br /> JZ L>`( (2D 4OPKIOS u d 715- S66- 461 <br /> Address Date CST Number <br /> 2-:71(vo N W 35 I�ESSTFa +fit- 54893 3 - 1(- 8 5670 <br />