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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 /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MtINTCItrAtTT Y: LOT NO :B <br /> . LK.NO.: SUBDI ISION NAME: <br /> ,51:'/4NE'/a 1`7 /T'Id N/R MI(.,)W �o 11`4 , � 1 4/9 1 /1/A <br /> COgU�1NTY: m OWNER'S BUYER'S NAME: !� ,{- MAILING ADDRESS: <br /> 11I,rh'e lJ k0e� �Utiw k'.,'/'f I 1_/1he t/t /til <br /> USE y VDATES OBSERVATIONS MADE <br /> I NO.BEDRMS.: COMME RCIAL DESCRIPTION: PIRIarILE DES RP S: PERCOLATION TESTS: <br /> L�Residence INNew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FI LL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> oS ❑u ®S ❑u M ❑u ❑S ®u ❑S au C0 wt/ <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5116),indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COL R, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OSERVED (SEE ABBRV.ON BACK.) <br /> 13- ( g0 9 9 No K) -r 7 � � _ r s'= �o " y� Y r <br /> B- Z 80 4 9 ,3 NbA-I- p > <br /> P <br /> / °� J 9, 199,x] IIPERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIO 1 PERIOD2 PERIOD PERINCH <br /> ---------------- <br /> P- ' 3 0 fv f%) / i <br /> P- 3 ju'o / s/ / J a- <br /> P. )v0 / 9 � � � Tib <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 dista ices. 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 bort gs and the direction and percent <br /> of land slope. A 8 F1 Ib O P4'11- 1 QfS7 46 C - 10" <br /> SYSTEM ELEVATION `l G, re d on OC-1 <br /> S C Q L'E 1 rr- q oI <br /> Uh ( esS A1oT�ed <br /> a� <br /> 0 <br /> TN <br /> a as ------ �• P a b I <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and in ithods 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 /> 0 C{'t rl C & - A—R L f'L r /U " — 0 <br /> ADDRESS: CERTIFICATION NUMBEF PHONE NUMBER(optional): <br /> IIer Wi'S � 37 r-- $66`9/S*7 <br /> CST N <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-8395 (R. 10/83) -OVER - <br />