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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, - DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,wl 53707 <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: OWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDI VISION NAME: <br /> GL-'/ s'/ /TQ/R (o W $Corr 7664) /-II s <br /> COUNTY: 0 NER'S/BUYER'S NAME: MAILING ADDRESS: <br /> &nu T� Off_ J3J'71t�. 457 )CQ_Vf1c /D AIAJ 53yz <br /> USE DATES OBSERVATION 3 MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILED I TI NS: PER OLATIO TESTS: <br /> �esidence �� Vew ❑Replace �7/f P �/7 e <br /> RATING: S=Site suitable for system U=Site unsuitable for system /0 L A <br /> CONVENTIONAL: MOUNcD: IN-GROUND-PRESSURE: SYSTEM-IN-F11'LLHOLDIINNG TANK: RECOMMENDED SYSTEM (optional) <br /> Egg �u J �u M �U EJu [:]S <br /> U <br /> If Percolation Tests are NOT required DESIGN RATE: If any y portion of the tested area is in the <br /> under s. ILHR 83.0915)Ibl,indicate: /J0�— I Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,CO R, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST— TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> B- I 66 105-'-6' t)c*c A31 �52_15. 53 roti S <br /> B- '� 7 " O6 S`l31 l07` s <br /> B 3 v U�,6.. �a� 7fry S` T5 7, " /3'-FS <br /> B 100 IDS �' ti ti ' (�GS"v�q T---, <br /> B- 7 66 I66'Q IU 7(� L4 �W s. <br /> B- <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 PER1003 PERINCH <br /> P- c/l" lJoil /0 ' M 3 <br /> P- <br /> P <br /> P <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of percolation tests, soil borings and a dimensions of suitable soil areas. Indicate scale or dista ices. Describe what are the fork <br /> zontal and v cal elevation reference points and show their to ion on the plot plan. Show the surface elevation at all bori gs and the direction and percent <br /> oflandsl e. �O�L6r/ 57A!<c— <br /> SY TE ELEVATION S <br /> � I r, <br /> /fir 45 o B Pt <br /> 0, <br /> I6 z4 /� w4q,f#E12x <br /> e3 <br /> 271& <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and rot th ds 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 COMPLETE ON: <br /> Cr y�E d Fr! 7 61d 7 (� <br /> ADDRESS: CERTIFICATION NUMBE PHONE NUMBER(optional): <br /> eP 5 A q7 0 0 i� l�wi� 6ti5-i ASc) .— / 3-/ - <br /> CSTSI RE: -� <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />