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INDU TRY, 0F REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND` PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> S' 5- <br /> AT'ION: TOWNSHIP/Mty6l .NU.: S <br /> idf@hpirLOT BLKUBDIVISION NAME: <br /> ►�` / / SECTION:/T3`) N/R! 'E-C�Qrl W <br /> COUNTY: OWNER'S BUYERS NAME: MAILING DDR SS: <br /> (�' 'lv'r7T I DEC4A/AJ I?% v7C 4'9 � �N7�st5'r.�> E ( �Is 5^?", lCi <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS,: CO M R AL RIPTION: ����/ IPROFILEDESCRIP aTION��TS: <br /> R [? <br /> [!Residence 9 New ❑Re lace I r �� <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL• MOUND: IN-GROUND• URE- STEM-IN-FILL HOLDING TANK: RECOMMENDEDSYSTEM:(optional) <br /> �S ❑U �S ❑U QS ❑U ❑S C7ULo Z I ,ti ✓ <br /> [unIder <br /> ercolaton Tests are NOT required DESIGN RATE: --••I If any portion of the lot is in the <br /> s.H63.091611b1,indicate: I Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL P HT R UNDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HTGHE—ST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- I ZS' l�J� ���' vE ,'7z4 „ t3% <br /> r� _ .r <br /> B- / z qc/� 0 4q > 72 Z ;r <br /> ,r t`- <br /> B =�� 99 �7r5 ��, s <br /> r rr <br /> B- W ?? 9`7^ 0 ' <br /> ' 3 &rn. S <br /> B- '72 <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 7 PE F3100 2 PERI015 3 PERPER INCH <br /> P- 1 y� _ h/C� 1 J 3 ,3• , 3 -i'4 z <br /> n <br /> P- 3 .30 3 3 <br /> P- <br /> P <br /> p. <br /> PLAN VIEW: 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 slop. <br /> SYSTEM ELEVATION 96 <br /> 1 <br /> ®14�r �� ��.. [,gyp►° <br /> 14 <br /> i f C i C 1 <br /> I <br /> e � <br /> C X IN <br /> Y v <br /> i <br /> f <br /> I - <br /> 11- <br /> +O E GAk t <br /> �'{/Eµ... r40 l�a' �U'�!'fJ.rJ_�A7N./t��_. 4. a.__ __.._ I � i _. i l� Rrc, l�R; g��.A', •--`r---�. <br /> 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin <br /> Admimistrative 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 /> calfs�� 4t1 JC F/ 0 13 / Y% — ;2 C? — r�C' <br /> ADDRESS: r,. t ., CERTIFICATION NUMBER: PHONE NUMBER optiorI <br /> h% � fax �/? �ani`�� /�lS .3 y'j c5.r 6/ 5/2 — <br /> CSTSISI,GGNATUR`E* <br /> DISTRIBUTION: Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester. <br /> DI LHR-SBD-6395 IN.03/81) <br />