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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (H63.09(1) & Chapter 145.045) <br /> t.00ATION" SECTION TOWNSHIP/ Y: LOT NO.:BLK.NO.: S UBDIVISIONNAME: <br /> sw 1 4 /T S/oN/R/Sp tart W .T.c so .1 N4 wk t1A <br /> C�QpLINTY }�- OWNE-R''ySIBUYER'S NAME: -1. MAILING ADDRESS: �/ ,,c <br /> /J4ri'l . T / �� p o - �lJ �f I c1. 0 6 0 C.�'P'l d u S / PQ 4 L AN^ S J-// <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS. COMM ERCIAL DESCRIPTION ,p{ _ PR FI IPTIONS: A NTESTS: <br /> Desiden e � 1 (]INew IFReplace a" / <br /> � � <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> CO�fqNNVENTIONWL MOUND IN-GfROO�UND-PRESSUREr SYSTEM-IV-FILLHOLDING TANK: R ECOMMENDED SYSTEM:(optional) <br /> Lp5 ❑UL S ❑]_._[�S ❑U 11:1SOU �_❑S � U c—l' UNV <br /> If Percolation Tests are NOT required DESIGN RATE: It any portion of the tested area is in the <br /> under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- I 8vi P ovj`e 789 s "e < bn-ed 3y" 62M,r, fr y/ " R C S <br /> B- �— 7�— S t > 3 / N R e- S <br /> B- g° 9S� > eyS " Re s <br /> B- � Sa Ig ' ` 7 14s /46o0 --Q- <br /> B- .._9a ' ` 3 T�gT <br /> 6- 7 Sa, Il LORCOLA M kTZMJ� .cS�'�M'f f�S �`!wQ 11te " <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERI D PERIOD PERIOD PER INCH <br /> P — S 3 <br /> P- <br /> P- I I1-- <br /> P- <br /> P- <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 and slope, <br /> SYSTEM ELEVATION 73. s- -re / p-e '6 M / ° ��~� ° <br /> I <br /> °d <br /> 18� <br /> I <br /> I, the undersigned, hereby c rtify that the soil tests reported on this form were made by me in accord with the proc2dures and methods specified in the Wisconsin <br /> Administrative Code,and that he data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> iNA E (pr ml TESTS WERE COM LIFTED ON: <br /> o d e.rl _ a 1�J►� f ------- ---___ ' / a' <br /> ADDRESS: - CERTIFICA NUMBER: PHONE NUMBER(optional): <br /> ,3 7tis-�h6-5/�0 <br /> C$�GN TURFti <br /> DISTRIBUTION: Original and one cop,to Local AuH:orty, Property Owner and Soil Tester, IIGJJ 1�/ <br /> Tl I_HR-SBD 6:195 M. 021SN - OVER -- <br />