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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 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> D * <br /> APPLICANT INFORMATION- Please print all information. Reviewed by n Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). C!j Z y V <br /> Property Own Property Location 4 G <br /> 1I �� Govt.Lot 5� 1/4//t-1/4,S / T g ,N,R 445rr)W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 2_71 ' <br /> City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road <br /> �PI 0//5c 1 5,11501 / )�� 6S <br /> LK New Construction Use: 29Residential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 6DD gpd Recommended design loading rate bed,gpd/ft2__A_!9 trench,gpd/1'12 <br /> Absorption area required bed,ft2�, O trench,ft? Maximum design loading rate��bed,gpd/ft2 , d trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s)L le/If/rp X `�S Af Id/J� 5 911 ft(as referred to site plan benchmark) <br /> Additional design/site considerations ol^ ct `-R-- �/ �t <br /> Parent material Cr��r�9-� /pa 1, r�A'ei' Flood plain elevation,if applicable 1,114-- <br /> 14-- ft <br /> S = Suitable for system Conventional I Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U Unsuitable for system S ❑ U I ❑s P] U Xs ❑ u ❑s X u ❑s 0 u ❑s MU <br /> SOIL DESCRIPTION REPORT <br /> Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring Consistence BoundaryflRootsin. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Bed ,Trench <br /> El CY <br /> Ground <br /> ele <br /> Depth to <br /> limiting <br /> factor <br /> Remarks: <br /> Boring# P7.'.0y — /� <br /> �Ground <br /> elY"I_ , <br /> ft. <br /> Depth to <br /> limiting <br /> ctor <br /> W—min. Remarks: <br /> CST Name (Please Print) KEN SCHMITZ INC. Signature / � Telephone No. <br /> Address 22835 Schmitz Lane Date CST Number <br /> SHELL LAKE, WI 54871 <br />