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• <br /> DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, G DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON BOX 7WI 53707 <br /> HUMAN RELATIONS <br /> (H63.09(1) & Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/ F6�RAL-rF-Y: 'LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> /Vie <br /> 1/ ,j4 <br /> 22 /1-4/0N/R/64-1(60‘)W stag,'- ..s— Mx! g+is SQ6d/v,S/QN <br /> COUNTY: OWNER'S/DUY-Eft'S NAME: MAILING ADDRESS: <br /> +'fc,2rf tH Q ,-S +�/c�� c!oti,s12++ct'�ind S717.9.e. ✓Z�, 5',-,e,,vr2, Gu=, -s-e,,,Pei <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> 1X1Residence2_ rviv g New Ell Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> —IS HU ._ .S U , RS U nS .x U : v.S x u - st . eed <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s.H63.09(5)(b),indicate: A!oP Floodplain, indicate Floodplain elevation: .4/.>9 <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- / 6,4 4PS/ Aver-oc > Go <br /> B- a 6,O 9?-.5" <br /> B-.3 �0 Q93' <br /> 49--,? E1`/ s/ Ts, 3- Ga'' r7 s. <br /> B- y 6o 99 0 ' <br /> B- ss- 6,0 99,'0 ' <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER SWELLING_ INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH <br /> — <br /> P_ 6, i o /1f0-+v-f. z. / %y / %y <br /> P- 7 Z-D AI aNC / 2-% / % / %y / <br /> P- if? ZQ Mooft! / / % / / / <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 land slope. <br /> SYSTEM ELEVATION 9: , o ' <br /> f / S'c <br /> V/0 I i 4 , .1 z- /z'gd.2 ' <br /> I E /u. �/ f?�e� <br /> . <br /> r Co I i J f��t 1 pie 11 1 .c <br /> ___... ___._ � .�. .;/ _... �_ i .�—��_._ ._.g ___, ..ter >/ __. <br /> Iit4 <br /> s-----.. .8'16,"...Sof J Wer F_..... _ <br /> l <br /> t , <br /> 3 I ( + I <br /> 11 <br /> € i i i 3 I I E t f i <br /> i t <br /> v � <br /> Nik39s' <br /> ( . <br /> I <br /> _ .. ) } <br /> I ' <br /> I,the undersigned, hereby certify that the soil testi 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 /> 4 A/ `/+ /17/62/.. 7-- <br /> 1✓`/62� — 7 ifs <br /> ADDRESS: i CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> O <br /> o + c 7// S)2004e�2 , w, ,S��o/ 333/ 2 <br /> �h -.?-isS <br /> CST SIGNATU • <br /> q <br /> DISTRIBUTION: Original and one copy to Local Authorit,Property Owner and Soil Tester. <br /> —OVER — <br /> DILHR-SBD-6395 (R.02/82) <br />