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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 83.09(11 &Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> sur'/ S ca � /T4l N/1116 E In /a ,v,4 7av � PivE�s�rE '9� <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> �aRA/L�f t' e, w ur<1.;� 6tacxlKEr�n/ ss»a <br /> USE ATES OBSERVATIONS l <br /> MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFIL D CR I PT IONS: ER OLATI ON TE: <br /> T <br /> �R esidance N n ❑New Replace I 6— r�o _ _L�R� <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURES STEM-IN-FI LLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> OS ❑U ®S ❑U EIS ❑U ❑S ®U EIS ®U evk-v <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.091511b I,indicate: A,/4 Floodplain, indicate Floodplain elevation: 1,, A-- <br /> PROFILE <br /> ,, A -- <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 EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B 6G I /oo o° l foul 4xO ' 4'k 131 T S S " & F S <br /> B- P 6 3 1,00-r3" fvouf 7 t-3" 1�I 6L-Tc', S N FS - <br /> B- :3lob /00�' hJO/u 7 (G6" �l" 6), r% 6L' vas <br /> B- la3 /001'3� rubitk 7(o3" Z4 r, Sy' <br /> i <br /> B- b leo /0,910" Nok 490 L /31 tS — gAj <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. PERIOD PERIOD PERIOD 3 PERINCH <br /> P- 0 r 1/ 7 <br /> P- " /00 10 9 l <br /> P r' A) <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 an the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION `� �� \ <br /> PPvv a` <br /> 3 oP av_,o.-_-- q, :AD <br /> ki <br /> T N <br /> Vh <br /> � � vz � <br /> I <br /> I,the undersigned, hereby certify that the soil tests reported on this (orm 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(print): _ TESTS WERE COMPLETED ON: <br /> oNA� T� L /die (i rr T Z a- <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 7 3 60x 970 (Ji S'-V836 S` ?6 2eAl-35-6 5 <br /> CST E: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. / <br /> DILHR-SBD-8395 IF, 10/83) —OVER — <br />