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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911)& Chapter 145) <br /> LOCATIONSECTION: TOWNSHIP/MUNICIPALITY: OT NO.: LK NO.: SUBDIVISION NAME: <br /> 6[. 1 : �/ 4 /TyoN/R/q E (p W scm <br /> 7LINTY: MAILIN ADDRESS: <br /> ( Ut1T JOE On 1,194q9 49• e-0 r/ E W o . 6V"8 <br /> 8 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DES RIPTI ON: � E TS: <br /> Residence ) ❑New Replace � � <br /> RATING:S-Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUND-PRFSSURE: S STEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ©S ❑u �S ❑u ®S ❑u OS ❑u ❑S MU <br /> If Percolation Tests are NOT required DESIGN RATE: Ii 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 GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED 1HE TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.1 <br /> B- i 114" 97'9" ND/ Z__ 114'' 1 " �L s� 1S I1C. <br /> B- log R" loZx. �, �L S�� �8 ` F- � ,S - <br /> EI- <br /> B- <br /> B- i II 'f I° g,, � I k3l_ . � �, 11C F, `�LS _ <br /> 0- <br /> PERCOLATION TESTS <br /> F EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE <br /> INCHES <br /> f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I P RI 02 <br /> P- <br /> P- 5 0 tj o luLr <br /> P- C <br /> P- <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate stale 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 /> T - <br /> 4+ P f44 wlszl Ngrc 9uv <br /> _ � ?�i7dof✓ 44� i}SaukaK�4�<- .' T--�-_ I --� i —i-' � 1' ~i� <br /> 3 <br /> N <br /> AAW <br /> -t-- <br /> f��i f i <br /> l <br /> I � I <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and m ds specified „th��e�Wiiissconsin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and b �lL�"""”` F= <br /> q <br /> ���2L/y <br /> NAME (print): TESTS WERE COM ON: <br /> 0ROi l7 8/ / 31 s <br /> ADDRESS: / � CE RTI FICA ION NUMBER: PHON NUMBERIoptiona0: <br /> r �Zo 'moi 7 S�f83o `X s 244 -iso S <br /> CST SLGNrt3URE: f <br /> DISTRIBUTION: Ongrnal and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBO6395 (R. 10/83) — OVER — <br />