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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, _ _. . DIVISION <br /> P.O. BO 7969 <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.091) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/AAUWI6WAl+TY LOT NOLK.NO. <br /> .:B : SUBpJVISII N NAM <br /> 4;1/4 NE1� 7 /T </pN/R /�flnr)W �iq ��or> �� A4d�t� �ek' �i�e,- �ki l <br /> COUNTY: OWNER'S/BUYER'S NAME:: MAILING ADDRESS: <br /> o r- /`0 L ty Sh if 17 11 -SO Ct>�. v a S C S <br /> USE DATES OBSERWIftIONS MADE <br /> ,,,R���yyy NO.BEDRNIS.: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: PERCO CATION TESTS: <br /> esidence ❑New ❑Replace 1 '5�_ 30, __O / <br /> RATING:S=Site suitable for system U=Site unsuitable for system S ii <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDINGTAN K: RECOMMENQED SYSTEM:(optional) <br /> ❑S ❑� ❑S ❑II ❑S ❑U EIS ❑U EIS ❑U I <br /> D <br /> If Percolation Tests are NOT required ESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.0915)Ibl,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- 9 ►- 7>-- 0-Y" 4«5. y - 3C "R f' 30 ' - '7aYiQ FY <br /> B- <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> _NUMTR INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PERIOD 3 PERINCH <br /> PP_ <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 /> SYST M ELEVATION <br /> �Q. <br /> 1` <Z. 1 N <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods 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 /> NA (pJrint): TESTS WERE COMPLETED ON: <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> S�3 <br /> c <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DI LHR-SBD 6395 (R. 10/83) —OVER — <br />