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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 'Z34/r,tJ <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.If <br /> © a <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)). <br /> Property Owner Property Location G 1 DD <br /> G �r /t Hook Lot s 1/4Jej 1/4,S/!tF- T To ,N,R 6 E(or <br /> Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# <br /> 3 4 fY� S7; /Poi 36- [o t _17 -� -W— <br /> city <br /> City State Zip Code Phone Number ❑ City ❑ Village LR Town Nearest Road <br /> $/rG/J 1w' ( ).T4f-?7 4�iC/ .�o� 8s/S'9 re•-ti -ve.-d <br /> $gNew Construction Use: gResidential/Number of bedrooms Addition to existing building <br /> ❑ Replacement ❑Public or commercial-Describe: <br /> Code derived daily flow gpd Recommended design loading rate ' 5bed,gpdM —, C/ trench,gpd/ft2 <br /> Absorption area required 95.9 bed,ft' trench,ft2 // Maximum design loading rate gibed,gpd/ft2 trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) 9S, I�P�r/k� qy, 3 ft(as referred to site plan benchmark) <br /> Additional design/site considerations <br /> Parent material es- G;,4 cy/ /f f Flood plain elevation,if applicable 00OV74 ft <br /> S = Suitable for system ,CC�ot�nventional Mound In-Ground Pressure ��AqqT,,-G�rade System in Fill Holding TTr�aarnk <br /> U = Unsuitable for system 9S ❑ U �S ❑ U N-S ❑ U $&S ❑ U 9Z ❑ U ❑S 19J U <br /> SOIL DESCRIPTION REPORT <br /> Horizon Depth Dominant Color Mottles Structure GPD/ft2 <br /> Boring# P Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench <br /> ;2- <br /> - 4-9 <br /> Ground 3 <br /> elev. <br /> 9�ft. <br /> Depth to <br /> limiting <br /> factor <br /> Uin. <br /> Remarks: <br /> Boring# <br /> /' <br /> B$Grroun/d <br /> IIdT/ <br /> n. <br /> Depth to <br /> limiting <br /> � <br /> f r <br /> in. Remarks: <br /> CST Name (Please Print) Signature Telephone No. <br /> ��dc !r o/ GcJao� 3Y9- <br /> Address e' Date .CST Number <br /> .30 e-s-/ �f�s3 <br />