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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, -_ - DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON W153707 <br /> HUMAN RELATIONS <br /> ((LHR 83.0911) & Chapter 145) <br /> L <br /> LOCATION: SECTION: TOHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> 0%a / AY N/R/SE(or)W WNSs V,g N AJ <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: 6 <br /> USE l DATES OBSERVATIONS MADE <br /> NO.B;DRMS.: <br /> O` COMMER IDESCRIPTION: PROFILE DESCRIPTIONS: <br /> '–ESR /lSNS: PERSOLATION TESTS S <br /> Replace C' OResidence IA XNew –OGG <br /> RATING:S=Site suitable—for system U=Site unsuitable for system : <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-F I LLHOLDI NG TANK: R ECOMME NDED SYSTEM:(optional) <br /> NS ❑U 1 QS ❑U ®S ❑U I ❑S ®U I ❑S ®U <br /> If Percolation Tests DESIGN RATE:are NOT required �If any portion of the tested area is in the <br /> 09151161 <br /> under s. ILHR 83. ,indicate: N Floodplain, indicate Floodplain elevation: N <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALD PTH TO GROUNDWATER-INCHES CHARACTER OF SOI WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- r ko ', c]q p'` NoNC <br /> B z y ,l ciq"q 36` P175 - 61,RE <br /> B- Vo 7d` I S &K fsa8` 6- 5N 1=s <br /> B- a /66�p` t V11-Us > LIG ' ` I <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 PERIOD PERIOD PERINCH <br /> P- <br /> P <br /> P y i �i cr <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-6r distances. Describe what are the hori- <br /> zontal and vertical elevation reference points and show their location on the plot plan. Show the surface.-te—vation at all borings and the direction and percent <br /> of land slope. \\ <br /> SYSTEM ELEVATIONgi rl <br /> g D bi-'n <br /> z \ / <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 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 OMPLETED ON: <br /> h�0 til "D � �R ® S' <br /> ADD ESS: 7_ CERTIFICATION NUMBER: PHONE NUMB Ell(national): <br /> _7 S-may 3Sa <br /> CS SIGNA RE: r+ <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. L— <br /> DILHR-SBD6395 (R. 10/83) –OVER – <br />