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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 /> HU AN RELATIONS <br /> (ILHR 83.09(7) &Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/mbwtCtPA-rTry LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> 14 N /(o /T18N/R17EIpr Dari i e /r CS/I V6 ? <br /> COUNTY: OWNER'S 'S NAME: MAILING ADDRESS: <br /> garhe,79' Do441,t 4xpel 39s" LOck ori' <br /> USE V 15ATES OBSERVAirIONS MACrE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: � PR"OF L DESCRIPTIONS: R ATION TESTS: <br /> Residence New Replace �y�y � <br /> RATING: S=Site suitable for system U=Site unsuitable for system V <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: -IN-FI LL HOLDING TANK: RECOMMENDED SYSTEM:Ioptional) <br /> ❑S ®II ❑S �U ❑S DS <br /> ®U ❑U /di 7`ank <br /> SIGN RATE:E <br /> If Percolation Tests are NOT required DIf 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 DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) Af <br /> CD 7910 <br /> B" SOU ' rVO`+L �p i� 0—/0" Q/ / - /O"—_2151" /fin c Zoo,- /0" <br /> B- �r3 /" / 001 oner a_q.,�IC /- y"-3i"//� c �. �iC'D /y, at qo, <br /> B- 3 /qr' LIQ '/o" paw /o', D/U" "'rf0"� 47f- /O" <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEV L-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD P PERINCH <br /> P- L Y"OH fJ —W k rG �O r0 d Ill <br /> P- <br /> P- <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 <br /> 8-a I <br /> o <br /> -- 63f X /.2f <br /> f wo be,_l i'to6,l� lig ,e at <br /> oo' <br /> � _ TN <br /> w <br /> 6-1 <br /> L3A VR P <br /> ooYe hi(rc 44e ,-&,r-. . `/ i; .�-� Mddrwt J7 k <br /> Al <br /> I,the undersigned, hereby certify that the soil t form were made by me in accord with the procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the data recorded an n o0he tests are correct to the best of my knowledge and belief. <br /> NAME(print): TESTS WERE COMPLETED ON: <br /> ya'llace_ J, 'Re'07'1001 a C /9 <br /> ADDRESS: CERTIF CATI NUMBER: JPHONE NUMBER(optional): <br /> �• lYo 60 1 Vek ter- , C.STOO ' -7 7/rL6-,P <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHRSBD$395(R, 10/83) —OVER — (/ <br />