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DEPARTMENT OF ` `Jh(J! Tft"_ , /:Yl- J `�+ `;`j= ��>' ". " '��; ✓ ETY & BUILDINGS <br /> INDUSTRY, REPORT ON SOIL BORINGS AND DIVISION <br /> LABOR ANDPERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (I LHR 83.09111& Chapter 145) t-l_� j_ �); <br /> LOCATION: f SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> Nw 4 Nom/ II /T 3%N/R/V E (or Rte S k qc.re <br /> COUNTY: -y�/�y/�., hjO �eve� MAILINGAAul_`HESS: <br /> rh rn.l�FT' l� /SO0 /�/GcYTI N zI.n� �C Sr�.,CY_ S ��C) <br /> USE DATES OBSERVATIONS ADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: ESTS- <br /> Residence - — lace / / s TL/�� <br /> RATING:S=Site suitable for system U=Site unsuitable for system Y <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:topti II <br /> ❑$ ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U 5vc�� �>,�� <br /> If Percolation Tests are NOT required DESIGN RATE: If any y 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 DEP H TO GROUIN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED H ST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 7,2 Alu <br /> B <br /> B- <br /> B- <br /> B <br /> B- <br /> PERCOLATION TESTS <br /> 1TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> i NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI D2 p R PERINCH <br /> P- <br /> P- <br /> P- <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 _1j,)r-e <br /> OLD <br /> /'S <br /> �wD! is Tumor-e �1^cnl <br /> tN <br /> t'1vuSC_.Is� � L�)Y)� Gds -- <br /> /s rc �eY✓LQ)1 �1�6- <br /> 1 __ i _.1�cbse✓ co �cref 2 uThe,. C. 0 <br /> I /s <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 COMPLETED ON: <br /> Q "e 7 -a'�/-90 <br /> ADDRESS. CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> / 3 bL�' h 5 S�i - <br /> CST yIGNATUR <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD6395 (R. 10/831 -OVER - <br />