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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 /> Jo 3,17 o Ile a <br /> APPLICANT INFORMATION - Please print all information. Reviewed by Date <br /> Personal information you provide may be used for secondary purposes(Privacy taw,s.15.04(1)(m)). <br /> Pro erty Owner Property Location <br /> Tr 10C I+,4,J Govt.Lot AlC 1/45'C 1/4,S T.35,N,R E(or W <br /> Property Owner's Mailing Address y, Q Lot# Block# Subd.Name or CSM# <br /> .Z 0 o w e r^ R G/• -- <br /> City t State Zip Code Phone Number ❑ City "❑ �Town Village Nearest Road <br /> 5�0�.� w,r sf�7� ( ).3s�-s5'3J sii^�,J csc•J�/` <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 . 7 bed,gpd/ft21�trench,gpd/ft2 <br /> Absorption area required bed,ft2 �7s trench,ft Maximum design loading rate , 7 bed,gpd/f2 <br /> trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) TSo 9 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material C-,` iy* d /] 7g- Flood plain elevation,if applicable A119- ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure, AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system RS ❑ U Mz ❑ U 9'S ❑ U as ❑ U 9S ❑ U ❑S XU <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 /> 0-3 <br /> e- Ca . 7 <br /> Ground /� 7'"; cr 6.4 Jai / .7 ivy <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> in. ' <br /> Remarks: <br /> Boring# <br /> -47.S „L' 1' /S C o f e <br /> Ground <br /> elev� <br /> Depth to <br /> limiting <br /> fac or <br /> in. Remarks: <br /> CST Name (P/lease Print) Signature y Telephone No. <br /> OI <br /> Address c Date CST Number <br /> ZcsX -9k 9S83 <br />