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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> 7969 <br /> LABOR AND - PERCOLATION TESTS (115) MADISON,P.O. BOX PERCOLATION WI 533707707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: T WNSHIP/MUNICIPALITY: LOT NO.:BL NO.j SUBDI SION NAny E: <br /> 1/5 1/ /T`pN/R Flo Jacksow 2ww '! 1 a ,i 9K7r <br /> C UNTY: W E BUY 'S NA E: MAILING ADDRESS: Sys�a-1 <br /> t5 r a J u ,.� ox 1057 <br /> USE DATES OBSERVATION MADE <br /> NO.BED .: COM ERCIAL DESCRIPTION: PR ILE ESCRIPTI S: PER O TION TESTS: <br /> Residence of �� New ❑Replace rl a^ l,4 <br /> RATING:S=Site suitable for system U=Sita unsuitable for system I' <br /> CON❑VENTDeQ MOUND: ®U IN-GEIND URE: SVS❑TEM-I N-FILL HOXS EJNK: RECO ENDED SVSTEM (optional) <br /> If Percolation Tests are NOT required DESI CyN RA E' If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: N Floodplain,indicate Floodplain elevation: /'VIA <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTHTOGROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, CO OR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON E ACK.) <br /> B- ,q 93 mss93t' /S / Y <br /> B-D- 3111 5191' / 1 <br /> 113h S lore S I '14 <br /> u <br /> rt <br /> B-3 3y q�,26 '� a.0h � f' erg <br /> B- ij 411" 96.33' yin 37 3 7 '& S 5 "/3h S�iti Lv <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PE R7= PERINCH <br /> P- <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 distE noes. 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 bori gs and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION �a / 5� , <br /> "IF Sm- 10"Oe,kffea <br /> 11-sp�y��' <br /> sftof��Gf��„a 4ssa, de�. <br /> v =13bre+-QLes foo ' 7 <br /> s 1-4&d he's b"A) 6gl o0-10 I Iq <br /> F, I lid t > S! T N <br /> SCo o►J �q5t Sltw- Ot <br /> �, fa,il is 4c, slfp Foy <br /> Y1C-4 tAnyg <br /> a ll a��4-u fl.¢ <br /> -tb low foY stl M rY1w !Q {OSI CActas <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and ff ethods 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): i1 TESTS WERE COMPLETE ON: <br /> ADDRESS: 1 �� W l.- w� �, ) 0 CERTIFICATION NUM1: PHONE NUMBER IoDtiona0: <br /> l� 0 3-S-7- as3 - S9 <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395(R. 10/83) —OVER — <br />