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Wisconsin Department of Commerce SOIL AND SITE EVALUATION <br /> Division of Satety and Buildings <br /> Bureau of Integrated services in accordance with s. ILHR 83.09,Wis.Adm. Code Page_of <br /> Attach complete site plan on paper not less than 81/2 x 11 Indies in size. Plan must County <br /> include,but rat limited to: vertical and horizontal reference pant(BM),direction and u"6,r <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# <br /> Qa 8 131- a/ <br /> APPLICANT INFORMATION- Please print all information. Reviewed by/ Date <br /> rm <br /> Personal intoetion you provide may be used for secondary purposes(Privacy Law.s.15.04(1)(m)). ��" ' ///W f 7 <br /> Property Owner Property Location ^^ <br /> G A M1 GovL Lot 1/4 1/4,S 3 T "It/ ,N,R14 E(or w <br /> Property Ownilirs Mailing Address Lot# Block# Subd.Name or CSM# <br /> 2172(00 IRDYIF5014 F-D. 149S AclxgS <br /> City State Zip Code Phone Number ❑ City El 1148 ® Town Nearest Road <br /> I W1 54 3 415 )W-S6941 SCOW <br /> ❑New Construction Use: ®Residential/Number of bedrooms 4 Addition to existing building <br /> W Replacement /,,, El Public or commercial-Describe: <br /> Code derived daily flow 1 00 gpd Recommended design loading rate - 7 bed,gpd/ftz •15trench,gpd* <br /> Absorption area required abed,n2 f O trench,ft2 <br /> nn Maximum design loading rate—1--7 —bed,gpd/ftz • S trench,gpd/ftz <br /> Recommended infiltration surface elevation(s) '1Z. 4s ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material GLAcmii. DRift Flood plain elevation,if applicable lVtl ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> U unsuitable for system ®S ❑ U ®S ❑ U RIS ❑ U I ®S ❑ U ®S ❑ U ❑S 5a U <br /> SOIL DESCRIPTION REPORT <br /> Boring# Horizon Depth Dominant Color Mottles Structure GPD/f12 <br /> in. Munsell Ou.Sz.Cont.Color Texture Gr.Sz.Sh. Consistence Boundary Roots <br /> Bed ,Trench <br /> I I -S I.5 IE -5 Z til S 1 C5 4 f .1 8 <br /> Ground <br /> 9 ev ft. , <br /> Depth to <br /> limiting <br /> fa , <br /> Remarks: <br /> Boring# <br /> t -S . 8 <br /> 13 5- 7•S <br /> aGround <br /> 1'— <br /> �ft. <br /> Depth to <br /> limiting <br /> facior 811W Ad4k �IbR <br /> in. Remarks: <br /> ST Name (Please Print) Signature Telephone No. <br /> tCHAIZO 14PPk1n1s kms,( '71-5- 8(.P64L5 7 <br /> - <br /> Addre Date CST Nurgber <br /> 2-776o 14 wy 35 WE95TI x,11•,54893 /1_R_q7 336,70 <br />