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Wisconsin Department of commerce SOIL AND SITE EVALUATION <br /> Division of Safety and Buildings Page of <br /> Bureau of IntegrWed 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 /> 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. PdfcsI I.D.# <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)). ��f <br /> Property Owner Property Location by, <br /> t Kr <br /> DOLA6 LEBALGovL Lot 1/4 1/4,S Z7 T 4 1 •N,R 'S E(orG) <br /> Property Owners Mailing Address Lot# Bkxic# Subd.Name or CSM# <br /> N. 4238 SPUR Ro. oz,55 <br /> City State Zip Code Phone Number ❑ City ❑ village ® Town Nearest Road <br /> WKjtJ5 i Ot545 0 (7►s )AKS-77 901 5wi55 1 6664,C Lk R17. <br /> El Now cors kziUstet: ❑Residential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate bed,gpd* trench,gpd/ftz <br /> Absorption area required bed,ft2 /► trench,ft2 Maximum design loading rate bed,gpd/ft2 trench,gpd4t2 <br /> Recommended infiltration surface elevakm(s) q 5..,s ft(as referred o site plan benchmark) <br /> Additional design/site considerations 1 1Ziyv &K14C <br /> Parent material anal_ QWT Food plain elevation,if applicable NA ft <br /> S = Suitable for system Conv►gVp/goral Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = unsuitable for system ❑S �l u ❑s ❑ u ❑s ❑ u ❑s ❑ u ❑s ❑ u ❑s ❑ u <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles 4TexlturmeStructure Consistence Boundary RootsGPD/ft2 <br /> in. Munsell Ou.Sz.Cont.Colorr.Sz.Sh. Bed ,Trench <br /> 13I 0 7.s 7- ^ �' o d/ S Z✓ . 7 . 8I-s a t. -L— n;s dl 4,5 2 ; g <br /> Ground $ /��- A0 OS �`� -7 <br /> Nov. , <br /> Depth to <br /> limiting <br /> r _ <br /> lin. <br /> Remarks: <br /> Boring# <br /> L] <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> _in. Remarks: <br /> CST Name (Please Print Signatu a Telephone No. <br /> (HARD pWj45 866- +S-7 <br /> Address <br /> 3S W635TER lnrl. S49" Date CST Number <br /> Z�7w <br /> 4-2g- q$ X70 <br />