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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 /> MADISON, <br /> HUMAN RELATIONS SON,WI 53707 <br /> (ILHR 83.091) & Chapter 145) <br /> LOCATION: SECTIOTOWNSHIP/MUNICIPALITY: LOT NO.:BL('Y!Br: �AME. <br /> R/SEIo h�' ov '1074 o? <br /> ,JC / II�1/ 7 �TOON onG <br /> COUNTY: OWNER'S BUYER'S N, ME: MAILING ADDRESS: <br /> ,Burnett Lonce /7 ,Lso o?P�/3 /✓ &S 57. A/.,5.177irnnea, JAi ,mc/ssy/P <br /> USE DATES OBSERVATIONS MADE <br /> �-,/ NO.BEDRMS.: COMMER IAL DESCRIPTION: PR FILE DESCRIPTIONS- PER OLATION TESTS: <br /> LYJResidence ]New Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTI O❑NAL: MOU D:❑u IN-Gcgs P❑u RE: SEI S IMU I EI SG®�'TAN . R CT�.loptionall <br /> II��11 D <br /> If Percolation Tests are NOT required ESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.091511b1,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.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- / ,�r 9P 3 XIC0G 10�" 0-7WZ/, 7"-(o�"G1'imed. s; "- 7,?"C w/.emof <br /> B- ��?" 99 ,t/one 0/" G•e✓3 i' G�'�xa s; Ui tr- �a~ci wie,.wt <br /> 777— <br /> B 3 fir, 99. 10 ,t/�e Cay!" o-7"BI ai; 7'-6,v',!%mC-'7"'5"W'_ 7a7 ciwlelwt Ff <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERI0D2 PERIOD PERINCH <br /> P- /CX7G .5 � / <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 97V 5ccr/c /"� ve) <br /> &16-n of ®7c/1i79 <br /> A/oaev 06'63 A Ai <br /> 1� <br /> �'�A8W o Pere <br /> �Qm F s 9e <br /> Lake � T N <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in acrd cowith the procedures and methods specified in the Wiscc'+nsin <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 /> NAM (print)' TESTS WERE COMPLETED ON: <br /> .t22de %u�/x�/m ,9u u3f 6. /9PP <br /> ADDRE.S,s CERTIFICATION NUMBER: PHONE NUMB ER(optional): <br /> C358.5 (lis Pleb- �Z <br /> CSTSIGN�tTURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />