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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 /> 3707 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (I LHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY LOT NO.:BLK.NO.: SUBD VISION NAME: <br /> 6L'140 7 �/4 /3 /T 6N/R// E In W v.vra,v /A A;i+ /72i Pim secs <br /> COUNTY: WNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> uETT C— ti AJ "FZ s 9 <br /> USE DA ES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: fes] PROFILED SCRIPTI NS: ER OLATION TESTS: <br /> Residence (9_ N A XNew ❑Replace ` /_ <br /> RATING: S=Site suitable for system U=Site unsuitaabblle for system <br /> CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM.(optional) <br /> ®S ❑U ©S ❑U ®S ❑U ❑S ®U ❑S DU L00vUEXJ7/6,0L <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.0' indicate: �/A- Floodplain,indicate Floodplain elevation: <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- 76" 94:-6. NcrVILJC- 76 s" s4Ts 9 a 8/';F-5 Z_'3 '6M <br /> B- 2 7�rr %4 6 n16ME 78 " a�K Sirs ys , s. !' fo n�xtzaD.c5 a7"BMS <br /> B- 3 78 6, /)ONE 77S*' 5„ 3/14 stirs 4/6., 31vr, ' ms <br /> I . . <br /> B- q 76 ° 99b A)DUE 7ly " 5- '' 6).K 5),T5 . q8 8Nf, ,r rams <br /> 13- 6- 79 9gt6 r MC E 7 7Y, S" gRIL 5/, TS 48' it ! ' cb�,qvsr)4_.S 4#em <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. PERI0D1 PERIOD PERIOD 3 PERINCH <br /> P_ I eti' S ! 5/ ' / a <br /> P- u= i' 7 <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 dist inces. 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 bori igs and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION 6" yew eif �z <br /> I I <br /> I <br /> �jrp � .7qi n <br /> 7001011,U TIC <br /> X7a1fgd r <br /> I 1 I lo' <br /> I <br /> I, the undersigned, hereby certify that the soil tests report d on this form were made by me in accord with the procedures and r iethods specified in the W sconsin <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(: 1 p TESTS WERE/COMPLETED ON: <br /> ADDRESS: CERTIFICATION NUMBl PHONE NUMBER(o tional): <br /> �T 3 S o x 970 �Hi�� /9. i� all , S'/CBCT S �i i- aW3so q <br /> I <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br /> t <br />