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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 u <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel II .# J <br /> APPLICANT INFORMATION - Please print all information. eviewed 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 n <br /> Govt.Lot w 1/4,4g 1/4,S j"{. T41 1 .,N,R 15' E(or)o <br /> Property OwneeA Mailing Address Lot# Block# I Subd.Name or CSM# <br /> -5-R ID kff5 <br /> City State Zip Code Phone Number p City ❑ Village Town Nearest Road <br /> 9055RIN 1141`455,,,ttt o o (2?01396-2?21 SW15-5 <br /> New Construction Use: Residential/Number of bedrooms Z' Additidn td existing building <br /> Replacement Public or commercial-Describe: •-t a <br /> Code derived daily flow 300 gpd Recommended design loading rate I bed,gpd/fIF .a trench,gpd/tt2, <br /> Absorption area required _bed,ft2 31S trench,ft2 Maximum design loading rate bed,gpd/fl2. trench,gpd/ft2 <br /> Recommended infiltration surface elevation(s) ft(as referred to site pian benchmark) <br /> Additional design/site considerations <br /> Parent material 4E LIAC SIM Flood plain elevation,if applicable /'14 .--ft,. <br /> S = Suitable for system Conventional Mound In-Ground Pressur� Rs <br /> AT-Grade System in Fill Holding Tank <br /> U = Unsuitable for system S ❑ U _LMS ❑ U S ❑ U ❑ U 70s ElU ❑S VU <br /> SOIL DESCRIPTION REPORT <br /> BOflflg# Horizon Depth Dominant Color Mottles Structure- - ` GPD, <br /> Texture Consistence Boundary Roots <br /> in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench <br /> ...._y....N. <br /> LIP <br /> ;xD-4 I-Sig _ S S t� Co ..7 . 8 <br /> i <br /> Ground 1, IR b G i D l5 M 7 .E <br /> i14 2 <br /> Depth to <br /> limiting <br /> factpr <br /> 7in. <br /> Remarks: <br /> Boring# <br /> I 0-4-56 <br /> S IZ A b <br /> Ground 4 7Z <br /> ft. <br /> Depth to 5 <br /> limiting <br /> factor vat <br /> J <br /> in. Remarks: NJ11fn nu.g" Borg►>rrc <br /> CST Name (Please Print) Signature Telephone No. <br /> 57 tN o wl~two( 1 S• 8G6- r <br /> Addless Date CST Number <br /> 2..'l Z&o Nw 35 E&sTOZ 111. ,#%" •3 • � 2.25$51 <br />