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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, - -- -- DIVISION <br /> LABOR AND PERCOLATION TESTS `115) MADISON,WI 53707 <br /> P.O. BOX 7969 <br /> HUMAN RELATIONS \ / <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/N1CN}CtPXCLTTY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> YVA4A -' y 3S /Ty/ N/R/6t(nr1W sw; .rs NA VA I <br /> CI(UNTY: OWNER'S/BUYER'S NAME: �.d r MAI LING ADDRESS:: <br /> [� 4fAY !1 /)o t" 7 //E' <br /> 3 / 0, �i'r rT C 77 Lj:, ."Y SA O a. <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMMER IAL DESCRIPTION: PROFILEDES RIPTIONS: ER OLATI N TESTS: <br /> ®Residence c ®New ❑Replace I �// q' f � / V F <br /> RATING:S=Site suitable for system U=Site unsuitable for system / fs / v / <br /> C NVENTIONAL MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED <br /> S ❑Q NS ❑A NS ❑U I ❑S ©U ❑$ COA.) 0Hill <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is <br /> under s. ILHR 63.09151(6),indicate: Floodplain, indicate Floodplain el <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 /> B / Iv�►�e ,6" secs � 'r- o" R~M� �J a a ', 7a " s <br /> B a e f, `7 " Q.6"glcs <br /> B- 0 0E7 f� 0 017"R(4S 7"-o Rrmt- S — QC t. <br /> Vvmj -r <br /> B- y E 1 ( Q -V'Jell[ to n-a6 , s*tris A0 '�- 0 " o c <br /> B S 7 I Off I I 7F7 0.7`fd [ (s a `rte 87" ryt r $ <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 PERIOD PERIOD 3 PER INCH <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. C L%J /(f C� e �-- <br /> SYSTEM ELEVATION / �' ' I CL o P 4 <br /> I T <br /> sCQl,e "1 '`' q s <br /> 1tn Cess A 13Tral <br /> Fire � S-�a3rb ? /dc^ o aF7' <br /> s�,rs<t <br /> NA I <br /> TN <br /> I � <br /> a' <br /> ort 11li SS' /CL R ( sTq/(e Q tit ,/B o <br /> • Wr �l <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(pr in , r TESTS WERE COMPLE D ON: <br /> oIle +-; t the /F nr 3 l <br /> ADDRESS: j CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> y <br /> CS G�URE <br /> hr <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester, v <br /> D I LH R SB D-6395 (R. 10/83) —OVER — <br />