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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON769 <br /> WI 53707 <br /> HUMAN RELATIONS <br /> ((LHR 83.0911) &Chapter 1451 gq. <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISIONNAME: <br /> �V4 I/ /T N/R E (q W pw GoD V• V <br /> COUNTY: MAILING ADDRESS: <br /> U ►J RAL-VH IcH t 0 L R <br /> USE DATES OBSERVATIONS MA E <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: NS: PERCOLATION TESTS: <br /> ❑Residence 2 r� _ New ❑Replace - /0- C= 3' <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> �VTI❑U . M®S. EU IN-G23S ❑U E: SV"N"S IOUL O❑SG®U RECOMMENDED CO�V,5ffl7A1PLloptiona0 <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: y _� Floodplain, indicate Floodplain elevation: N}a <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL PTH TO GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHESTTO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 97HOOF ?'jZ o-(OSlnu G- 72'8up►s <br /> B- 2 Z 99.S N04E >77- <br /> B- 3 <br /> zB- 3 00.q )72 <br /> B 4 IM. Nor1E 0- ��"►' <br /> B-s Sq 1M. XON6 b- (. 31r1s b- VA 3,41"15 <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 PERI D2 PERIOD 3 PERINCH <br /> P_ I ' <br /> P- 2 No S 17) ,, 3 <br /> P- 3 No L116 3 <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 97•ZF T SfAtE I; Yo <br /> { , , eOm+�nQpu <br /> tJW <br /> N <br /> _ _ __ <br /> _ a <br /> a s - <br /> a _ <br /> I ' <br /> , <br /> 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the�Joce r and m hod�pecified in the Wisconsin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my kno IiefK(,E$" <br /> : TESTS WERE COMPLETE <br /> Ka <br /> NAME (print O <br /> I n „� 0 5- 3 <br /> ADDRESS: CERTIFICATION NUMBER: P ONE NUMBER(optional): <br /> 2 W �3 3(&70 - 6 /S <br /> CST SIGNATURE: <br /> DISTRIBUTION:Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) -OVER - <br />