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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> 3707 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/ LOT NO.:BILK.NO.: SUB IVISION NAME: <br /> /TWN/R/SE — <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> &/'/7e-# 471 4471 Al 6ronfJ6U , <br /> USE _ DATES OBS VATIO JS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCR IPTI NS: ERCOLATION TESTS: <br /> Residence �) ❑New Replace <br /> RATING: S=Site suitable for system U=Site unsuitable for system /7 <br /> ONVENTIONAL: MOUND: IN-GROUND-PPR -IN-FI LLHOLDI NG TANK: R ECOMM ENDED SYSTE I:Ioptional) <br /> ®S ❑U CJS ❑U ®S ❑U E U ❑S ,U G�nve��/on / <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)lb),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL 0 DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, C LOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATII N OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED ((—SEE ABBRV. ON BACK.) <br /> B- / ��" 9l'J•J ���e /� " <br /> 0 <br /> -6"61,5/i 6O"-a67,..&7 »Ji S7H- 7-7= eS <br /> B-a 7a" 9/JpB / 7,? " <br /> B-3 W u 7tJ /UO/7C' ) 7,? - ",61 CO `B/7 --,5;jr, 7o7=25h CS <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD P_E RIOD2 PERIOD PERINCH <br /> P- O <br /> P- 3 '7" A101.7e <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 dis antes. 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 hot ngs and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION 9�: a/e /"= �4'eXeePf I� here nofco� <br /> &*n7 aid nQ <br /> d �riitQ 4 a <br /> o Peln <br /> m/of3fa,Ee Q o?�/ TN <br /> y7o X <br /> c 30 <br /> ai. <br /> �d P� <br /> `4/!t3 /0 �e <br /> _IPPrDI!. 370' <br /> v <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and nethods 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): ITESTS WERE COMPLET D ON: <br /> wale I&I ho/n , 1 / '- / 16, 19,!56 <br /> ADDRESS: J ' CERTIFICATION S63 <br /> CST SIGNUMB R: r/ / NUMBER�a O/optional): <br /> 30 <br /> A/ NATRE: OCO[o oto <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />