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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, _ DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53907 <br /> HUMAN RELATIONS <br /> (H63.0911)& Chapter 145.045) <br /> LOCATION SECTION: TOWNSHIP/M11AAG1BAL+T-Y: LOT NO.: <br /> � BLKNO. SUBDIVISION NAME <br /> /T.3N/R/ W4 � NA <br /> NN �aA <br /> COUNTY OWNER'S BtW-6 'S NAME: MAILING ADDRESS: <br /> HF A17hb P NF AT 2 max 'i <br /> .76 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.'1COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS <br /> RAesidence 3 AIA ;RNew New ❑Repe � /_ <br /> by <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM- N-FI LLHOLDI NG TANK. RECOMMENDED SYSTEM:lopnonatl <br /> [Ns ❑u res ❑u ®s ❑u ❑s_ m ❑s Au 1" <br /> N RATE:: <br /> If Percolation Tests are NOT required DESIf any portion of the tested area is in the <br /> under s.H63.091511b1,indicate: J /} I Floodplain, indicate Floodplain elevation, NA <br /> PROFILL DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND pEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHES TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.1 <br /> B- I 17 / e C o"1;7 7� iS'L �� /3,., �' ierB 5 Ls <br /> or <br /> e_ 3 '7-2- q - N uNr" 5"y 13-, <br /> B. y 2 9'- 5i , <br /> CNS r � ,. � � �f/, ;moi /� "`1" L <br /> r. <br /> B. /72 q9 - G ' ory i 4 "r3 s y" S 2 '' i3-, <br /> 4 72- <br /> PERCOLATION TESTS <br /> DEPTH TER IN HOLE TEST TIME WATER LEVEL-INCHES RATE MINUTES <br /> PER INCHESAFTERSWELLING INTERVAL-MIN. o PER INCH <br /> 3 3 .2P• J <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori <br /> zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent <br /> of land slope. <br /> i <br /> SYSTEM ELEVATION <br /> CRvicerarcoa An ------- — <br /> - FIDE NC H• � ixlzw <br /> D = goRc r"c5T �f7opo,cd ��tu 4;ett� <br /> �►nr w <br /> A, VRP f 'pOPC PRI✓i-4' ;N•jd 'YLN— <br /> c e.� t N <br /> fo a) i; , I typt <br /> X Yo <br /> 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the data recorded arici location of the tests are correct to the best of my knowledge and belief. <br /> ,NAME(print): TESTS WERE COMPLETED ON: <br /> '4�'PWARU , y- -.- <br /> ADDRESS: - - CERTIFICATION NUMBER: P ONE NUMBERIoptional): <br /> Rr .? illor 9/40 VRZAA1 U11I S!i 2 cST 6)4.21 <br /> S �`> <br /> CST SIGN/MATURE: <br /> DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> i DILHR-SBD-6395 IR.02/82) —OVER — <br />