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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 6 - -/33s�- 0a.- Y6 v <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)). ���- ?v <br /> Property Owner Property Location //'ss <br /> &^Ac/ 14,e e—�S Govt.Lot `Y 1/4 1/4,S35' T yo ,N,R/e E(orJ2 <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> ,,? 7f1_33? w e®A),j er . �P� kl i 4..2s4 <br /> City / State Zip Code Phone Number ❑ City ❑ Village 19 Town Nearest Road <br /> G�r� /fie AdZ S'Y8 3 ( I 0AK/.¢tib ' < <-aivnlef�. <br /> ❑ New Construction Use: Residential/Number of bedrooms =m3 Addition to existing building <br /> Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 1.J0 gpd Recommended design loading rate,_ bed,gpd/ft2--or�trench,gpd/ft2 <br /> Absorption,area required _37.5 bed,ft2 -375 trench,ft Maximum design loading rate / 7 bed,gpd/ft2 •8 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ! y 3 ft(as referred to site plan benchmark) <br /> Additional design/site considerations / �1 �c c�.s .� ® �!O/c%�✓Q 7�i9�✓it- <br /> Parent <br /> Parent material / 474- Flood plain elevation,if applicable <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade <br /> System in Fill Holding Tank <br /> U = Unsuitable for system ❑ S U RIS U ❑ S U [_] <br /> S IJ.U ❑S +tel U ❑S XU <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 /> 0 7.SyiQ <br /> Ground 3 9. ,y/ <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> ,Min. <br /> Remarks: <br /> Boring # <br /> 7.s <br /> Ground <br /> elev. <br /> Depth to <br /> limiting <br /> factor <br /> 47—in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> Address Date CST Number <br />