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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> DIVISION <br /> INDUSTRY, - -_ <br /> LABORMADISON,WI 533707707 <br /> A`ND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/IbIIRrCTP7iLTT F LOT NO.:BLK.NO.: SUBDI ISION NAME: <br /> L.1 '/ sE '/ a y /T y6NIF41F(or)W s c o T/ ,vJ4 �o v Co i s <br /> CBUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> pyr•nY c) 6'o pr* To t- RT Age)( 10S- S o o Y r <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER CIAL DESCRIPTION: PROFILED SCrR IPTIC NS: PER OLATI ON TESTS: <br /> Residence New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system / <br /> CONVECcNTIONAL: MOUNpD: IN_ -GROUNp-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM (optional) <br /> ,JJ ❑U ®$ ❑U ❑ S ©U ❑$ A ❑$ ❑xU lgogl ( <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)(6),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COL OR,TEXTURE, AND DEPTH <br /> NUMBER pEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SE7.E AB BR V.ON ACK.) <br /> �. b *'49 J (i a-7 ^e* e 7 hMt 601 <br /> B- l s.� �v N 0 IJ-,e. 7 L" „„o 7- R c e. D y f S8 ,. B.„ d/L s A 7. S N H d <br /> t� q p �S"- 1"- r V- ,- Y}a ^r.ec� 0.9 . e/ 8n en t+ f <br /> B- G- I 96 , 0- 1 01 k,.., r Rcti.. v '1(0"-�! 9 " N O <br /> e.b ''B �^..•e r b `= 16 "/3^ .n•. J-b — Bn �,t•e J <br /> R S3 q6. d 61.010f.ot4 «o y "�ss . A 4,, 7z4 <br /> p tl U (P.r 64 .w�`r bN9"0A r S <br /> 13- S S•o a yn o T caw. D 9 SS n yn .d rc7n d <br /> 13- <br /> 13- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD ( PERIOD PERIOD PER INCH <br /> P- o �s// / 16, <br /> P-2- I a'/ N o <br /> P-3 a u 0 <br /> P_ N 0 <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 bori gs and the direction and percent <br /> of land slope. O aM to V4" L SN 3 <br /> SYSTEM ELEVATION 97.2 S r 4 I ". Yo r 4h Li, rs <br /> PVrt, • <br /> II .L4o.-e o <br /> (07. 4,N�e D R d E <br /> 0% <br /> loT <br /> ltw eh T PC <br /> a S' <br /> pt.opo st 1 <br /> ►7a fl.�l �t �l't7a <br /> LL <br /> ti <br /> � ttKCA Wtlr To beS/moo ' <br /> t tl Fn u ow. /tx O V e d <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and r iethods 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 COMPLETED ON: <br /> I t ` <br /> ADDRESS: CERTIFICATION NUMBER PHONE NUMBER(optional); <br /> e b s 7 Y sq 7 >/S gGd y/SYI <br /> CST N TUBE: <br /> O--BIpPDISTRIBUTION: Original Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />