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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 81/2 x 11 inches in size. Plan must County Q L <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 /> 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)). / aX <br /> Property Owner Property Location !!! <br /> 01(AtfR Govt.Lot 1/4 1/4,S 3, T 4 ,N,R 16 E(o W <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> .0. 130X 3= p <br /> Number City State Zip Code Phone Numb <br /> t \�� t_W 1, � ( �� ) El City EJ Village ,® Town Nearest Road <br /> W OAKtAtw I 014 ;s <br /> ,111 <br /> 0 New Construction Use: ❑Residential/Number of bedrooms 3 Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow 45-0 gpd Recommended design loading rate bed,gpd/ft2—LI—trench,gpd/ft2 <br /> Absorption area required b 43 bed,ft2 S�trench,ft2 Maximum design loading rate , 7 bed,gpd/ft2_�trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9t;, /�YLT �!• 8 ft(as referred to site plan benchmark) <br /> Additional design/site considerations ih vroan�� �rrSst, Q fisr &A ife <br /> Parent material 67ac_ta Flood plain elevation,if applicable 4Z/-ft <br /> S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank <br /> u = unsuitable for system ❑ s 1: u ❑ s ❑ u ❑S ❑ u ❑ s ❑ u ❑ s ❑ u ❑ S ❑ U <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 /> Z o-cf 7.SY m- 5 5. 6, rn f CS 3Co <br /> 7 , <br /> M 5. 5.(, r� C 5. X m .7 <br /> Ground 3 56-6f1 7,S S Calc} rr-j� s7 <br /> elev. 5• I C S. ' 7 8 <br /> Depth to <br /> limiting <br /> factor <br /> 4L� in. <br /> Remarks: <br /> Boring# <br /> O-q 7.s � '/ m• s. 5, 6:. I c.s 3 o -7 . <br /> a' 4-vq -7.5-i2 y/y A1. S. 5. G. d m 7 T <br /> -17 13 13 Y/? rJ IiI.S. S, <br /> G. 1m I C.S. .7 , <br /> Ground ls-ne �� G�.d 5"r,Ps� ,f,.s s G. �„ ) c. . — •7 -� <br /> elev. <br /> Depth to ' <br /> limiting <br /> factor <br /> -�'7 in. Remarks: 140rrLer-\ d� wtff-1 Gr. <br /> CST Name (Please Print) Signature Telephone No. <br /> ATkA� <br /> C�1RRI) 1' q/ b- 5 <br /> Add ss �_7 Date <br /> �l " 1 CST Number <br /> Q c- <br />