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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY,- DIVISION <br /> LABOR7969 <br /> HUMAN RELATIONS MADISON,WI 533707707 <br /> AND PERCOLATION TESTS (115) P.O. BOX <br /> HUM <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT O.:BLK.NO.: SUBD VISION NAME: <br /> kl% � '/ 3� /T 0/Rj6 E (orlW 0A KLANC) ► 6 • (IUW LAKE ESTATES <br /> COUNTY: OWNER'S/BUVER'S NAME: MAILING ADDRESS: <br /> Burge- W _ Coy 2(a Kgollwooi 17i Fivef FaI15 W1 22_ <br /> USEDATES OBSERVATIOP,S MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: P OFIL NS: ATION TESTS: <br /> Residence �7 New ❑Replace � <br /> RATING:S=Site suitable for system U=Site unsuitable for system 1 1 O <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ®$ ❑U k$ ❑u I $ ®u ❑$ ®U MtJLE'41-[7 <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> Q —� 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 GROUP DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> B- I 2 I $'3 Nous > '7Z 0- 5"9 goi meds 59= ;? H 8rN /4eds <br /> B1 72_ qSII > 3Z 0- 57XoJiiaS �7 -7Z48rNM0JS <br /> B- 3 q0 gti•9 > So 0 61 Rrmmeds Its1- 76 /1 &tj Meds <br /> B-�l 72- 17 1 72- o b- gni r*Ie s 63 ` 72 2rN mm' <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 PERIOD2 P R [P/ERINCH <br /> P- tau 3- 7 <br /> P o <br /> P- Z Ni 'r 2 <br /> 11P- <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 borir gs and the direction and percent <br /> of land slope. pz*c 11 V AU- if"� '10'Ek C 214 wpere N^ied <br /> SYSTEM ELEVATION 97 2 E�f- ; /Q� NRR.fu eA�e 'E L&C_ . P01-E <br /> QSe"Mea`� <br /> • <br /> � a <br /> e <br /> Z�r <br /> a <br /> aM <br /> 114�y 5 T N <br /> ,C9"CH SOO 15 5ewEQ USE NES [o HIEN )S ySC' FROM L07 14 W411 16 EFlSEM,EJJ <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and m thods 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 /> NANIF(print): TESTS WERE COMPLETE ON: <br /> !� od -enlc o qhs g7 <br /> ADDRESS: CERTIFICATION NUMBE : PHONE NUMBER(optional): <br /> 61-7q r- w i S. L3 71s-- 866-N/-T7 <br /> CS A URE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 IF, 10/83) —OVER — <br />