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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 /> (H63.0911)& Chapter 145.045) <br /> A SECTION: TOWNSHIP/MtlN+e+f- tTTT: LOT NO.:BLK.NO.: SUB DIVISION NAME: <br /> 1 1/ /TY6N/R/jE (p ) a7 <br /> COUNTY: OWNER'S BUX-ERS#&ME: MAILING ADDRESS: <br /> u � 1 �utl v DO /S ST#tL S aor✓o✓1 � fsu <br /> USE ATES OBSE VATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: ���777��077 PROFILE DES RIPT ONS: ER A N TESTS: <br /> Residence 2-- yy New ❑Replace I S �S <br /> RATING:S=Site suitable for system U=Site unsuitable for system \ J� <br /> M <br /> CONVENTIONAL: OUND: IN-GROUNDFRESSURE: S STEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ®s ou [js ®u FIs cru ❑sou os ©u <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALD PTH 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 /> d �s <br /> B- 7iV )00. 5 Now/r' > J 51"t3 / TS l3'f s / Ib" / V.1-4P./®`rs o! ti <br /> B- 7i 7?�' la,. 5 <br /> B- 3 7 s,- /oa5 Saand`. <br /> 3� �cS <br /> B- I 7 b /o o >'2 L q" 131 T5 t3if 5 1 10"6e!,,, <br /> B- 5 7 Y J00 SI'ruc_ <br /> B- (, L /oo —5 <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI D2 PhHluu j PERINCH <br /> P- 3G S tse l' lie <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. <br /> SYSTEM ELEVATION 97 <br /> I <br /> pirt, Are <br /> L <br /> 2 /�� I. Q.-. tenn8s/ !�' _.. . .. _ A�+ tH <br /> ltw� <br /> , <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 (print): TESTS WERE COMPL TED ON: <br /> /ysrceL L <br /> ADDRESS: 1 . CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 30 (,o fk ! do :5 SS ,22iv X66 - rf? 9�3 <br /> CST SIGNATURE: � <br /> s <br /> DISTRIBUTION: Original and one copy to Local Authority.Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />