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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND. PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWN'H'P'MUN'C'PAL'TY ILOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> ,Ile /P /TV61111/GE (p(9i/and 7&k1,-),5171; <br /> CO�INTY: OWNER'S/BUYER'S NAME: MAIL ADDRESS: <br /> OUi�Je7� s / i; J3"ff <br /> ATE <br /> USE S OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS:1PERCOLATION TESTS: <br /> %Residence XNew ❑Replace 1// /x <br /> RATING:S=Site suitable for system U=Site unsuitable for system /7 <br /> Qtr�TI❑� . N19�1XI�. El U1 <br /> IN GO S P❑U RE: SVSOTEM-IN-FULFI❑�GIAIN <br /> � . RECOMMENDED <br /> er,�OnSYSTEM:(oPtio(optional) <br /> Percolation e N DESIGN RATE: S (�]JI (�_// <br /> If Percolation Tests are NOT required If any portion of the tested area is in the <br /> under s. ILHR 8309indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH 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 /> B- / 9P 9 JVO/7e > <br /> B_ <br /> B- S/199 /f/0/2 If > " some a.5 d/ <br /> e- S W" 160.,5- Jt/on e > 7a „ 0-520,91-1b9" 7-?"rte rneC1% 3 <br /> e- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODI PERIOD PERIOD 3 PER INCH <br /> P- / P" one .1?S o? '/ a <br /> P- 33 xe e /b J/ ' <br /> P- 3 i(/ a Y17 <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 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. no%o! <br /> s APPrex., 4/5-7 ' <br /> � /4ioProX. �3C10' — T��y <br /> 'Cod &.1 P/ <br /> P3a,g3 <br /> giver T N <br /> 'g,-a a� <br /> 3 — <br /> v <br /> �y.. .O ,Benchmark., .a Qor�n9 <br /> NLir� � 64+se of P" Oa.f� o Pere <br /> I, th 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 /> NA ( rind: TESTS WERE COMPLETED ON: <br /> eAoft <br /> Aw <br /> A SS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> VIV ,�D. �YoT�s re%k3 �c/I JS3 3SP3 qx:0R6& - ;W?& <br /> ' - CST SIGNATURE: /y <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395(R 10/83) —OVER — <br />