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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 /> HUMAN RELATIONS <br /> (1163.0911)& Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDI ISION NAME: <br /> 3 6, /T/aN/R ISE (n ITa c ,e n 3 Nn <br /> COUNTY: ' <br /> OWNER'SBUYER'S NAM E: MAI LIN ADDRESS: <br /> u n l! .ja �• r� w di, r/ /IIIA <br /> USE DATES OBSERVATION MADE <br /> NO.BL�EDRMS: COMMERCIAL DESCRIPTION: IIqq IPR�F�j�SCji�TIO, 5: E /��Ohj�TESTS: <br /> Residence ❑New �p Replace / (o/ // !o <br /> J' <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVEppNTIONAL: MOUNIpD: IN-GROUNNpD-PRESSURE: SYSTEppM-IN-FILLHOLDIINpNG TANK:RECOMMENDED SYST/E-M;(optional) <br /> ®J ❑U ❑J �U ❑J ©U ❑J ©U ❑J ®U � � Nvehro n <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the , I JI <br /> under s.HN <br /> 63.09(5)(b),indicate: 4 I Floodplain, indicate Floodplain elevation: N/,[—LJ <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,CO OR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> / I <br /> B- / 7 ?" yy. 6 V ysl o=s dl. Ix, s"al'a 27-"28' , ,"�� . <br /> B- So e y or <br /> ,t N <br /> B- .3 N o rig FK D-y 16) /.S r gnedx. - 3-9 n- nnsds. kllY, clood, W5,, <br /> ft <br /> g- y F10 V. s /1/0 O,r aR1 h"l,;' Y5,-ki 'Lo n J <br /> B- n <br /> NJX. <br /> B- S 8,11 <br /> 9 A16 n ".B/. /s A!- e d Sia -8/�rhe J s <br /> R <br /> PERCOLATION TESTS --// /� <br /> theJS. CG�Q✓ S"Joo/f $ Q1 � /G. /✓ <br /> /JOd 8NI• <br /> P <br /> DEPTH WATERINHOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> INCHES AFTERSWELLING INTERVAL-MIN. PERIODI PERIOD2 P R D PERINCH1 o3 u- <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 horn <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. D r Q <br /> SYSTEM ELEVATION <br /> y <br /> At <br /> N to ;Jl <br /> v I <br /> ,BawdPitO� y? <br /> tab, Nem e _ I !3 J/ 45 � <br /> L <br /> W 6a .av`le — _ OrJL rs <br /> ASA '!s 0'? j6of•� ro To,..a roIj <br /> f _ <br /> -pool t . 'a44e.:t. -.�' .S�OYA..0 //t . Cf%q/L���a. .f1o/ <br /> JId <br /> o " peG /6(! IL�bf iSJ1 <br /> )1,the undersigned, hereby certify that the soil tests reported on this form were made by mein 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 /> /s- <br /> ADDR SS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> none � " 35, <br /> 0 <br /> y <br /> CST GNA U <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> -- <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />