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DEPARTMENT OF I SAFETY & BUILDINGS <br /> INDUSTRY, REPORT ON SOIL BORINGS AND DIVISION <br /> LABOR AND <br /> PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HLI,AAN RELATIONS MADISON,WI 53707 <br /> (ILHR 83.090) & Chapter 145) <br /> LOCATION: S TION: - TOWNSHIP/MUNICIP LITY: LOTNO.:BLK.NO.: SUB (VISION NAME: <br /> W �/ u )/ /Tyo N/R 61 ler)W v �, III N� 0 1 <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:-6 <br /> DDRESS: q� <br /> 64r� n .� rtlf Q / 3 P ��Y Nf <br /> USE DATES ERVATI NS MADE <br /> NO.BEDRMS: COMMER AL DESCRIPTION: N EST <br /> Residence 2New ❑Replace <br /> RATING:S-Site suitable for system U=Site unsuitable for system <br /> CONVENT( NAL: MOUND: 1' GROUN6PRESSURE: SYSTEM-IN-FI I,L HOLDING TANK: RECOMMENDED SYSTE :(optional) <br /> ©$ ❑U Z $ ❑U $ ❑U ❑S ®U ❑$ CRU _ 0A) <br /> If Percolation Tests are NOT required DESIGN RATE: If 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-GR.UN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. I HEST TO BEDROCK IF OBSERVED (SEE ABBRV.O BACK.) <br /> / � 9q Lj S 6,r t /6 ' 79 'I <br /> B- It O iI > / <br /> B� q 7.3 7 7 <br /> B- � t1 IN <br /> B- 7 7 <br /> B_ <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 1 PERIOD PERIOD PER INCH <br /> P. 3 ti 10 � a //// a SY /�1 5L <br /> P. Z. 0 u o 7 ;La- <br /> P- 3 r N- t) <br /> P- <br /> P- <br /> P. <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the ffimensions of suitable soil areas. Indicate scale or dis antes. Describe what are the hori- <br /> zontal and vertical elevation reference points and show their location on the plot plan. Show b S tzurface elevation at all bouings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION c/� y B hn foo <br /> uQi L iu <br /> P "W 4, 1ti <br /> a. T N <br /> �f tiF <br /> I, the undersigned, hereby certify that the soil tests reported on t is 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 /> NAME (prin/} TESTS WERE COMPLET D ON: <br /> 0 <br /> ADDRESS CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> s-T r- ' s J? <br /> CST ATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br />