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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> P.O. BOX 769 <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (H63.090)& Chapter 145.045) <br /> LOCA SECTION: TOWNSHIP/MtlN12fP*L - LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> /� �/a /o /TYoN/R/`�Elo 5e_� i Ln 5 rsr y �i5 <br /> TY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> 13 Vrtnr.�l c�c �l 21 /9je /`7-!'r 2 �3Scr� +c S �5 SSSNO <br /> USE DATES OBSER ATION MAEJE <br /> NO.BEDRMS: COMMER IAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLAI ON TESTS: <br /> X[Residence I New ❑Replace I . 6-9-- •�//2 �$./ <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND TIN-GROUND-PRESSURE: SYSTEM-IN-FI LL HOLDING T NK: RECOMMENDED SYSTEM:(optional) <br /> ©S ❑U I ES Mu I �S ❑U IS [2 ❑SCU <br /> I <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the I <br /> under s.H63.09(5)(b),indicate: I I Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D 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- -2 > 7f ` br_,� 51 7s Yy'17 S 3�" <br /> B- 2- <br /> B--3 <br /> _B--3 7 Ss' I <br /> B- d -22-- . m -r5 y2-"%1.V50 <br /> B 7 i y9S <br /> B- b 7 L- �— <br /> PERCOLATION TESTS <br /> TESTDEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD P RI D PER INCH <br /> P_ is , ,, ) f' 3 <br /> P - L I.3 f' (Jib __3 <br /> P- <br /> P- <br /> P-_ <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil area 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 su evation at all borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION F6 , 5�- 6 \ <br /> a- <br /> 13.M, <br /> QK, <br /> ,, TN <br /> �- <br /> . S� aL <br /> � t { <br /> sr— �9 �Inr z <br /> I <br /> all "A <br /> I <br /> I,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 and the location of the tests are correct to the best of my knowledge and belief. <br /> NAME (print): TESTS WERE COMPLETED ON: <br /> an -t L_ c . fif' G�, 7 i z �sr <br /> AD RESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> SV R--5F '_� -)w I `1'E_ 'f7 9-3 <br /> CST SIGNATURE: �P <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> --SBD-6395 (R.02/82) —OVER — <br />