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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(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHI1`14464+W-HPt . LOT NO.:BLK.NO: SUBDIVIg ION NAME: <br /> E '/ uw'/a .?S MON/R08(orIW %7idrso A ,V�4- 0 ,f/-1 <br /> COUNTY: �-} OWNERS/BUYER'S NA E: MAILyIN—G ADDRESS: / '7�— p 5 <br /> 8 /Y7C f/ 1 C1P w1 lefvr E /Qt_ � Wr,t1( W1 . � 6 �S <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRNIS.: COMMERCIAL DESCRIPTION: XReplace PROFILE DESCRIPTIONS: ER LATIO TES <br /> Residence ❑New yv I /la C? & / l TS: <br /> QI <br /> RATING:S=Site suitable for system U=Site unsuitable for system 'O a P G ap <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ©S ❑U ©S ❑U XS ❑U [IS ©U ❑S DU I c 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 TOTALD PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED I E ABBRV.ON BACK.) <br /> v �e Q t /(7 - s <br /> B- 0 O > f 0 1.� as c <br /> 0lah , . o- p0 tv r tl/ IixA. p• AN <br /> 1� � 0 o�lo" A 6 r to:� y " R FI Ay'=110 <br /> B- u3. 6 7 w r tt <br /> B- <br /> B- <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_ 4 / 'U d 3/ of !3// W1 <br /> P- <br /> P- Ayt 10 rs// d 7 <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 and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION / I Boys <br /> PLrG• <br /> s� o ( n <br /> Ar "= ,!o ' <br /> v ,e. <br /> 1 <br /> 'kilt H �o <br /> S�A\�N <br /> ' <br /> 3 <br /> aA <br /> 51 kA <br /> ° T N <br /> Sped <br /> •O �Ck <br /> s Rd <br /> y <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified i 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 Ili t): TESTS WERE COMPLETED ON: <br /> �a _ )4o n J 61clo <br /> ADDRESS: I CERTIF ATION UMB R: PHONE NUMBER(optional): <br /> W,e 6 7.;r- wt s q3 7 1 7114s- Z <br /> C IG Afy T qE:_ <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-8395 (R. 10/83) —OVER — <br />