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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (I LHR 83.0911) & Chapter 145) <br /> LOCATION SECTION: TOWNSHIP/MUNICI PALI LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> �/ � �/ /TyDN/RIEE (or ;;ZZtgrt KfF es <br /> OUNTY: OWNER'S BUYER'S//N��AME: MAI�LIIIN�GADDRESS::J <br /> ul L:f'AVJ L� (f USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE ESC IPT ONS: PER OLATION TESTS: <br /> Residence 2 ��a New Replace I �/ �(G Syr <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL-❑N . Mwc.❑U INGISS PURE: SV®EM-I N❑-FILL HOEIS TANK: RECOMMENDED NUI O &3N-nM SYSTEM,(optional) <br /> If Percolation Tests are NOT required DESIGN RATE: S U If any portion of the tested area is in the "� <br /> under s. ILHR 83.09(5)(b),indicate: /VA_ Floodplain, indicate Floodplain elevation: rye <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- I ?d-" 14i jy low -7z° s _ T E � ' r_7!>r <br /> B ? ct� s rs �z` SFS <br /> B- 3 <br /> B_ rs�� 8`` 66 s <br /> B- o7 (00` r t y` &IL 61_1;� >?o ` (3 FS, <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. PERIOD1 PERIOD PERIOD PERINCH <br /> P_ _ /s t� q 3 <br /> P- 2 r <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 /> SYSTE ELEVATIONA 7 ria- x1we <br /> / I BrM, tD" 21.'�� rl�uz t�Tf WHfBoN <br /> A-t' 6�lrn� tomes o'r <br /> N0 -iVd!On --�� <br /> ?�-0n STAKL-ice o•�% k'���G <br /> RQr - --Y <br /> I Very I f N <br /> P541' y 1=- =- <br /> 2S I Ri <br /> I <br /> C-3 <br /> ss' <br /> I, the undersigne , hereby certify th4ethe soil tests reported on this form wereJ made by bby me in accord with the procedures and methods specified in the Wisconsin <br /> Administrative Co e,and that the data recorded and the location of the test(a1e; b9recP[o[he best of my knowledge and belief. <br /> NAME I�rf/1�1[1—'� ^ TESTS WERE OMPLETED ON: <br /> E) A) k:b � . QFt ( / joy <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional), <br /> PZTtea- `?�� o }i� cqw� �� 5I6� <br /> CST S1f5nATtJRE <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-8395 IR. 10/83) —OVER — <br />