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DEPARTKENTOF REPORT ON SOIL BORINGS AND <br />INDUSTRY,' <br />LABOR AND PERCOLATION TESTS (115) <br />HUMAN RELATIONS <br />(H63.09(1) &Chapter 145.045) <br />SAFETY & BUILDINGS <br />DIVISION <br />P.O. BOX 7969 <br />MADISON, WI 53707 <br />LOCATION: <br />SW 1/S 1/ <br />SECTION: <br />Z 6 /T39 N/R /6 F.*,) W <br />TOWNSHIP/Mk+hl+@1 4�Y: <br />/yg�/VON <br />LOT NO.:BLK. <br />3* <br />NO.: <br />N,f, <br />SUBDIVISION NAME: <br />/YA <br />COUNTY: <br />OWNER'S/ E: <br />MAILING ADDRESS: <br />// 77 <br />o/C E <br />756 WA oA �3�aarHi To /NI <br />RATING: S= Site suitahle for system LI= Site unsuitable for system <br />DATES OBSERVATIONS MADE �,7 7 __,;1 25 <br />1PROFI E DESCRIPTIONS: PERCOLATION TESTS: <br />CONVENT <br />NO. BEDRMS.: <br />COMMERCIAL DESCRIPTION: <br />El <br />Residence <br />Z <br />NA <br />New Replace <br />II <br />RATING: S= Site suitahle for system LI= Site unsuitable for system <br />DATES OBSERVATIONS MADE �,7 7 __,;1 25 <br />1PROFI E DESCRIPTIONS: PERCOLATION TESTS: <br />CONVENT <br />TOTAL <br />DEPTH IN, <br />U. <br />IMOUND:❑Sx� <br />INGaS PvwI�RE:SY❑S <br />IAULHI�JS <br />OBSERVED <br />EA <br />1 Ecfo1M0001414 SYSTEM: (optional) <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: /V Floodplain, indicate Floodplain elevation: Alt <br />PROFILE DESCRIPTIONS <br />BORING <br />NUMBER <br />TOTAL <br />DEPTH IN, <br />ELEVATION <br />DEPTH TO GROUNDWATER <br />-INCHES <br />CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br />TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) <br />OBSERVED <br />EST. HIGHEST <br />B- <br />L00 <br />Ivry TFA <br />s Gti u .046,57 <br />ti i/ <br />%D 9Z SLlo 22 9.17 Moos ©r 07 6-32 C -R4 <br />B <br />t <br />P_ I <br />To #IigHI9,4ouA)17 <br />io <br />E I <br />sL L57 a) �r o oris- 75 ('2 m, <br />B- 3 <br />a <br />99 9 <br />�� <br />/2 <br />`' Z st22"5 ^5e6 -D *o -f <br />, <br />1 <br />_ <br />5J_ 16 11 )3n C37L 29' CIM10 <br />B- <br />E <br />L TZ <br />/!� <br />B - <br />— <br />PERCOLATION TESTS <br />TEST DEPTH <br />NUMBER INCHES <br />WATER IN HOLE <br />AFTERSWELLING <br />TEST TIME <br />INTERVAL -MIN. <br />DROP IN WATER LEVEL -INCHES RATE MINUTES <br />PERIOD PERIOD2 PERIOD 3 PER INCH <br />P- <br />P_ <br />L00 <br />Ivry TFA <br />s Gti u .046,57 <br />P_ <br />I <br />t <br />P_ I <br />To #IigHI9,4ouA)17 <br />io <br />E I <br />TCR <br />—=p - <br />177- 7} <br />P_ <br />5, 4 �0004 <br />, <br />1 <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 />SYVEM ELEVATION /f0/0/N9 E4/Vk Re4u/RkA Z,9T Z IV.A� Aic409ox x„nr <br />E <br />MM , <br />f f <br />, <br />i c <br />c € <br />i <br />i <br />I <br />f <br />I <br />I <br />t <br />io <br />E I <br />. ...........j <br />I <br />177- 7} <br />-- -- <br />�?OF `_Tf�KE'TFEQ / <br />5, 4 �0004 <br />, <br />1 <br />_ <br />E <br />L TZ <br />/!� <br />— <br />�N <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 thj 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 <br />V11V 9F7s / 8 illy <br />ADDRESS: CERTIFICATIO NUM R: PHONE NUMBER (optional): <br />i � W is 5"� rs <br />CST SIATU <br />_ : <br />DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br />DILHR-SBD-6395 (R. 02/82) —OVER — <br />