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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, - DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> 3707 <br /> HUMAN RELATIONS MADISON,W15707 <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATIONSECTIO%� OIr1�R �E (or) TOWNSHIP/MUNICIPALITY LOT NO.:BLK.NO.: S DI ISIP NAME:` <br /> COUNTY: O NER'S/BUYER'SN ME: AI LIN ADDRESS: �)j�d/l�G` <br /> &UMs MN <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: �I P FILE DESCRIPTIO S: PER OLATION TESTS: <br /> esidence Ip'New ❑Replace /I I -Q Q-- <br /> RATING:S=Site suitable for system U=Site unsuitable for system I U v <br /> ONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:l optional) <br /> $ ❑U �$ ❑U S ❑U ❑SMU EIS 54U cnN�' <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09151(b I,indicate: �-/�— Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COL R,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHEST—TO BEDROCK IF OBSERVED (SEE ABBRV,ON BACK.) <br /> B- 978 0 X 7 2 0-`1 $11S `t'3Z F*� 3Z-7 N ms <br /> Z 00- ' 1 0- 5611 "l-3o6 " 5c) — 72 ft fri m <br /> B.3 " )I o—c� b2_q `� <br /> IIS ' � �N MS - ]Z ms <br /> B I Il "I . 0— ( S (9' Z-4 N M 5 19 Z 6N M <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. P RIOD1 PERIOD2 P RI D PER INCH <br /> P- 7-0 <br /> P- IVD I 32�/ �/ 3 <br /> P- J <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 distai ces. Describe what are the hori- <br /> zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevationn at all borrin is and the direction and percent <br /> of land slope. > 011t 1•v <br /> SYSTEM ELEVATION MOO poF-Ie V J <br /> s <br /> ELl <br /> TN <br /> DIZI V e � ELD6 . <br /> 30-)� $ ° <br /> .d <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and mi thuds 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 COMPhE E Of <br /> 2i Tb 6 L �S I `VLSI`, <br /> ADDRESS: CE IFICATION NUMBE : P ONE NUMBER(optional): <br /> W 6-?o <br /> CSTI�TURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />