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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 /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWN HIPIMUNICIP LITV: LOT NO.:ELK.NO.: SUBDIVISIONNAME: <br /> iYu/1/415611. /TW N/WIaE to G� /ond TAwizsfi� tlCo — idar�� �vcr�i�s <br /> COU TV: OWNER'S UYER'S NAME: MAILING ADDRE53: <br /> ,�Gl//7e� C/O a/ Fazsu�n ,5_/-. /7�11717ehaha. Ave. /1-211717dQ, As,/77,t/ 6: SV6t® <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFIL DESCRIPTI NS: PERCOLAT/L,JpN TE 5.TS: <br /> y�r+esidence -- New ❑Replace I�u/j/ � /�//// <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND:®S ❑U IN-G[K S [:]URE: SV❑STEM-I NFILL HOLDING❑sTFjNK: RECOMMENDED SVSTEM:Iyphonal) <br /> SS S U S Ir(wJ(U S ®U COnye�fior�ct/ <br /> DESIGN RATE: <br /> If Percolation Tests are NOT required If any portion of the tested area is in the <br /> under s. ILHR 83.09(511 b),intliCate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH 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 /> 13- <br /> B- <br /> B. a99. 9 ,c%re > P7/' <br /> 13­3 <br /> // / ii/one > p5/" '5'gMf Czs <br /> �a <br /> B- �! �7/ 999.. 13 NOn > SVr <br /> 13- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERQ PERINCH <br /> P_ .�" or�G s 3r� I? V a <br /> P- <br /> P- <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 /> SYS E ELEVATION <br /> APP"oY. 7/9' BM=/D0.0 1�U�lmcv(, .t/cti/ in bo e <br /> f - - - - - - - -/PO '- - - - - q O�/3 'gOC/- <br /> w <br /> o en. <br /> 0,49'6JIPT N <br /> v <br /> �v �0 <br /> by. <br /> Qet <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 /> it/Q�e ,eu�'s�o/m v/ 9,/9Ply <br /> ADDRESS: C RTIFICATION NUMBER: PHONE NUMBER(optional): <br /> o?'o�/o D %rpu�/,�ve. 5 �O. �X�?6 l c%63f�, l,�lls� L�s�'3 <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. `-- <br /> DILHR-SBD-6395 (R. 10183) —OVER — <br />