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Wisconsin DepaRand <br /> 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 Au)�W4- H <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. P''arrcel I.D.# <br /> APPLICANT INFORMATION- Please print all information. R ie b� to <br /> s' � O/ leo <br /> Personal information you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)). A) <br /> —SX <br /> Property Owner Property Location <br /> '5 4 Govt. Lot / 1/4 1/4,S zq/ T ,N,R/-5 I;OT)W <br /> Property Owner's Mailing Address( !Lot# Block# Subd. Name or CSM# <br /> 2 Q-71 <br /> City State Zip Code Phone Number ❑ Cltv Village J9 Town Nearest Road <br /> New Construction Use: MResidential/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/ft2 � trench,gpd/ft2 <br /> Absorption area required bed,ft2 — trench,ft2 Maximum design loading rate bed,gpd/ft2 ` trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) r C1/V ,/ n as referred to site plan benchma k) <br /> Additional design/site co siderations /4 f `� i /7y G°'/` <br /> I l <br /> Aee <br /> Parent material -(.- Flood plain elevation,if applicable / It <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system [:IS $U ❑S OU ❑ S MU <br /> ❑ S � U 0S 'MU S ❑ U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth I Dominant Color Mottles Structure GPD/112 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed Trench <br /> y3F is- Ic <br /> (Ground //- 0 /?!ci `fir Cl/j. a�Selrl <br /> I ,f If`J ric <br /> Depth to <br /> limiting <br /> facjcV <br /> in. <br /> Remarks: <br /> Boring # <br /> Ground <br /> 9 elev. <br /> Depth to <br /> limiting <br /> fa r <br /> in. Remarks: <br /> CST Name (Please Print) pp I(1�®jnaturree ,/` k. Telephone No. <br /> MPRStCST224.173 <br /> ms �A <br /> Address P.Q. BOX 160 wf to CST Number <br /> SHELL LAKE,WI 54871 7 7 <br />