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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, � DIVISION <br /> LABOR AND <br /> HUMAN RELATIONS \ /PERCOLATION TESTS !115) P.O. BOX 7969 <br /> (I LHR 83.09(1)& Chapter 145) MADISON,WI 53707 <br /> LOCATION: SECTION: TOWNSHIP/MON}C}tRt1TY-- OT NO.:BLK.NO.: SUB VISI NNAME: �5 <br /> PW'/4NE '/ 7 /T-fa N/R/6 E (or)W <br /> CQj1NTY: MAILING ADDRESS: S c �C <br /> Otilt t L ,,a Rill a 4± r / goc fro r N7' 41 r to <br /> USEE DATES OBSERVATIONS MADE <br /> NO.BEDRMS,: COMMERCIAL DESCRIPTION: A E TS: <br /> Residence � ;hew ❑Replace <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUNDPRESSl1RE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> $ ❑II S ❑II QS ❑u ❑S 5�0 ❑S izu L°� <br /> If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL P H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B-�— go R6l gofe e( < < <br /> B- ?�- qs.y a o n eC o it R t, <br /> B- <br /> B- <br /> 113- <br /> PERCOLATION <br /> B- <br /> PERCOLATION TESTS <br /> CTE57 DEPTH WATER IN HOLE TESTTIME DROP IN WATER L VEL-IN HES RATE MINUTES <br /> i NUMBER INCHES- AFTERSWELLING INTERVAL-MIN. P RI 01 p RI D2 p R PERINCH <br /> P- a0 <br /> s a a a <br /> P- N o s• a a. l �-- <br /> d Z s z a- <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 q3, ss- qo <br /> Iso' L <br /> Il rl To �� <br /> � � T _• <br /> 4 TN <br /> Ii1 � <br /> 4 /t a <br /> Xtra: �`w <br /> a <br /> L <br /> IlLr�y�s r l <br /> Ar <br /> 1 <br /> I, the underoned, hereby certify that the soil tests reported n this form were made by me in accord with he procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the data recorded and[he loran of the tests are correct to the best of my knowledge and belief. <br /> NAME print TESTS WERE COMPLETED ON: <br /> __ 07— a �- F <br /> ADDRESS CERTIFICATION NUMBER: PHONE-NUMBER(optional): <br /> IL 7 <br /> Q Y�AAAAy��77777 > s•8 <br /> C N URE: <br /> d'� _ <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. // <br /> DILHR-SBD6395 (R, 10/83) —OVER — <br />