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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 57969 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATISE TION: TOWNSHIP/MUNICIPALITY: LOTNO.:BLK.NO.: SUBDIVISIONNAME: <br /> 11/ '/4 / /TgON/R/51 (o W T cIz§01V ,4- u1- esm Vol .. �� a3g <br /> COUNTY: OWNER'S BUYER'S NAME: MAILIN ADDRESS: <br /> n/ S r&R 11N ss6sa <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: <br /> PROFILE S: A N TESTS: <br /> gtesidence f N,4- ONew �eplace I `6 &C� � 6 f6 ( <br /> RATING: S-Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ®S ❑U ®S E CSS U [701S El I El 4U I eo"ezr/onfi(i <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the A <br /> under s. ILHR 83.09(5)(b),indicate: IVA Floodplain, indicate Floodplain elevation: /00 <br /> PROFILE DESCRIPTIONS <br /> rB- <br /> TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> DEPTH IN. ELEVATION OBSERVED T. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> �0 1oe=o � > 9D' El'' /'t-� mEnS. �Z " /�>��. Pa✓. s . <br /> h- Cr > sS�T� /2� ! Iy1t1J moi �2111��. P Srp`.C; cls," S 5l- )S (cC� ' V11� � 15 t �n ejtoS <br /> B p0`-e` -7 9� S` 5LT�. 'CT Q i�L¢n4 — Ls> >3e.� s . <br /> 100-0r ) �l� S` SETS toR I'KL-7)S S` 14Lsl) 63 .) <br /> B- <br /> PERCOLATION TESTS <br /> RTESTDEPTH WATER IN HOLE TEST TIME DROP IN WATER L V L-IN HES RATE MINUTES <br /> INCHES AFTERSWELLING INTERVAL-MIN. PERI D1 PERI D2 PERINCH <br /> '' Ivc - 5 3 5 i 3PLOT 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. S " <br /> SYSTEM ELEVATION 96 <br /> �v <br /> 18e-o" eco-0' fw1 zls-tsL• <br /> gv5��sv�d pG+� , <br /> TowN I7.tpD •�s`• <br /> Nf753i�c � ` Ps m'o" <br /> t i Jt z fusty <br /> TN <br /> 23"i, °vim <br /> LAt� <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by a 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 /> NAME (pr' TESTS WE E COMPLETED ON: <br /> ADDRESS: CERTIFICATION NUMBER: PHONENUMBER(optional): <br /> l i\' 7 X4,, - >o <br /> c . UR <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> nil HR.RRII.F'On (R ln/R91 roro <br />