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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 /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNS HIP/M4N4etPRtifiY- LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> s�1/4 Sul '/ /T yoN/R 10(ort W Sc o /8 r•A GrY F P0COUNTY: it— OWNER''SS/BUYER'S NAME: MAInLING ADDRESS: / <br /> USE ATES OBSERVATIONS MADE <br /> Na BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> Residence ^ XNew [-]ReplaceI /O Sig <br /> RATING:S=Site suitable for system U=Site unsuitable for system V <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ®$ [__1 ®$ ❑U ®$ ❑U ❑$ ®U ❑$ DU C II ,uv. <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 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- 'PS to 1 . 3 polo-it 7 s"BII s /S"li is `=8sapokppl s <br /> B-a- '7 � 't 77Z 6-6"g<(r S '= l8 " . <�: /€ " 71" � S <br /> B-3 � � loo . " 7 8v 6 4 "141 i " "Bw 1,4.1 "-wit" k 4q,1..1 t' <br /> B S 73- 8.9 Is 7 7� - I),vr& 4 r <br /> 13- <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 PERIOD 3 PER INCH <br /> P_ S� JJm r3 / <br /> P- 7- go Pin f 3/ / 3 // Al <br /> P- <br /> P_ <br /> PLOTPLAN: 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 /> SYSTEM ELEVATION X 6 . 9 s li / � y o ' 1p r i o <br /> BEve a <br /> 1 Bti1 11 t <br /> t <br /> fall aed cad <br /> Ila <br /> TN <br /> BM <br /> I, the undersigned, hereby certify tl at the soil tests reported on this form were made by me in accord with the procedures and methods pec, n the Wisconsin <br /> Administrative Code,and that the di to recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> NAME (print): TESTS WERE COMPLETED <br /> /SON: <br /> AD RESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> W e 3 /S <br /> 8�14 <br /> T^RE <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-63951R. 10/83) —OVER — <br />