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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of P' <br /> safety and Buildings Page of <br /> aureau 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.O.# <br /> APPLICANT INFORMATION - Please print all information. Lleviewed by 0 Date <br /> Personal information you provide maybe used for secondary purposes(Privacy Law,s.-15A4(1)(m)). <br /> Property ,Owner Property Location <br /> . VVTI, Govt.Lot-3 1/4• 1/4,S T ,N,R �4, E(or W <br /> Property Owner's Mailing Address Lot# Block#T <br /> ujbd.Name orCSM# <br /> 1102D GLQJ 1 Z. voc.. ! P 2./7' ' <br /> City State Zip Code Phone Number <br /> �'1,) El City El Village P6Town Nearest Road i 885 OD 1 Co. go. E <br /> New Construction Use: Residential/Number of bedrooms 3 Addition to existing building <br /> Replacement N Public or commercial-Describe: {{ <br /> Code derived daily flow pd Recommended design loading rate bed,gpd/ft2 -4 trench,gpd/ft2 <br /> Absorption area r uired bed,n2 trench,ft Maximum design loading rate bed,gpd/ff2 _trench,gpd/n2 <br /> Recommended infiltration surface elevation(s) /013 n(as referred to site plan benchmark) <br /> Additional design/site considerations A#mv Suer4oa Its q x r <br /> Parent material GIA(JAL Mi. Flood plain elevation,if applicable-9A n <br /> S Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U Unsuitable for system ❑ S X U [ Cgs ❑ U ❑ S Dq U I ❑S J4 U ❑S MU ;13 ❑ U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> in. Munsell Qu.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed , Trench <br /> z <br /> X 4 /�� �s o/ all" g S- 6 <br /> Ground q• � le�' 4 r 1 / H � �i i.� .S , . 6 <br /> fin. <br /> Depth to <br /> limiting <br /> Tfor ' <br /> Tin. <br /> Remarks: <br /> Boring # <br /> 2� -s �-' S b5f, d5 c;1111 --J- - . 5, 6 <br /> Ground 4 $- <br /> e ' <br /> Depth to <br /> limiting <br /> Tct r <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> «}Al2D ,4s 76-866- S <br /> Addr ssDate CST Number <br /> 2 o 35 1,JF.sst�R -1- S 2258St <br />