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DEPARTMEN•i OF REPORTLON SOIL BORINGS AND SAFETY& BUILDINGS
<br /> INDUSTRY, 4.,
<br /> DIVISION
<br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
<br /> HUMAN RELATIONS
<br /> ,�L CAT N: SECTION: TOWNSHIP/Mt,1Q1CIN74LITY: LOT NO.:BLK.NO.: SUBDIVISION NAME:
<br /> ° �'`F/�c�/ 3y /T N/R,srlW ..)ACKs0r
<br /> COUNTY: OWNER'S/B°t11`ER'S NAME: MAILING ADDRESS:
<br /> Au 4r de -i,V /`-///i t'cC 9& _cr'4,6-rt,'' / S 5 ‘(i'-9 Z
<br /> USE DATES OBSERVATIONS MADE
<br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: ,_PROFILE DESCRIPTIONS: PERCOLATION TESTS:
<br /> Residence 2- C Er New ❑Replace 1e, / 3 et i 0 _ / 3 .-w
<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:loptional)
<br /> [7S ❑U DSDU DSDU CS DU DSDU
<br /> If Percolation Tests are NOT required DESIGN RATE:SYSTEM ELEV. If any portion of the lot is in the
<br /> under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation:
<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- z 71 9• /e„ ,, .1 "2 /3/ r'S, Yi`;3,%, S, 4 „/s, /! "'3->, S.
<br /> B- 3 7a loo - y,, rl 'I 2 ''6I Ts, 6k,,eT s, „ ` , c s
<br /> B- 'I 72 r p ''e y„ it ., I r '' i f
<br /> B- ' 72 160, 8s' r► ,r ', 'I ,r
<br /> j. "
<br /> B- `f` 7G P�f 'a" '' r. r, r,
<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 /> P_ I 2V t.i o l0 -'tG 3 3 3
<br /> p_ 2 .3 c' ni 0 10 3 `-V 3-Gr '3 3
<br /> P- 3 3(c rl1 G' 10 3 "-h. 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 R7- V"
<br /> Ho c:seig
<br /> Qz t3o c rEsr
<br /> c-IA:Rc 7657- 0r %rnJ r:
<br /> n
<br /> ,..ePr Pdvpo , 0
<br /> Fr
<br /> ma iu ii : 3h;v,sT LOT- 9 �� k:�•3E +�G:.14Tr al
<br /> a.�
<br /> AN.� `" - v
<br /> 0 -77'V.fr 4erx3, 2C'X3a'' • 2 't,IA "ost. c- TN
<br /> ct /o't7r r-- 17PT TFF73 PI�I /.oi-,K 4
<br /> /3-3 = gO pT, r Toleed ;31Pa ,z E4 i ct
<br /> Fi G� + — 7CC' ---- IL
<br /> Ft'S ,,rA is FOk• A
<br /> I &I) ,N AI/i FL.l» .D RA,A FL L7
<br /> :
<br /> /Yi414')11 O 4r4 KC- Ad
<br /> I, 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 /> Eck.)Akr) ic 5-cNogO66eR ,..0 - /3 - ?✓
<br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):
<br /> CST SIGNATURE:.if fc: / �)a—,d .r-'_L'.-,
<br /> DISTRIBUTION: Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester.
<br /> DILHR-SBD-6395(N.03/81) �/
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