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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, - DIVISION <br /> 7969 <br /> LABOR AND P.O. BOX PERCOLATION TESTS (115) MADISON,WI 533707707 <br /> HUMAN RELATIONS <br /> (1 LHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT N0.:8LK.NO.: SUED(,VISION NAME: <br /> 0 �/4Oe lo /TSN/Rl4Elo IN 4(44-DAl A- N4 MA <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> 5Vucir T -0/ z 9s7 sT 6 IV A.1 D� <br /> USE DATES OBSERVATIO S MADE <br /> COMMER IALDESCRI PTION: PROFIL DES R TI NS ER OLATION TESTS: <br /> 17s�(esidence h ,L XNew ❑Replace �$_ <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTI ONAL: MOUND: IN-GROUNUPRESSURE: SYSTEM-IN-F I LLHOLDI NG TANK: R ECOMMENDED SYSTEMC(optional) <br /> ❑U LAS ❑U �S ❑U E SU ❑S CSU C' <br /> G <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the I N <br /> under s. ILHR 83.09(5)(W,indicate: 'N q- Floodplain,indicate Floodplain elevation: <br /> I <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,CO�OR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> o� 0 <br /> B- <br /> B- <br /> B- a 66" 6V �louE 66 5 13/ 5l. TS 61- R r S . <br /> B- 3 0 "" �/' ►JoHE 57' 6 - B 1 s4 T-S . S2" R P, S <br /> B- 772," NoaE 71-" 5 6L ,s ice , <br /> 13- 5 g° �� 6.r Doc7 ?9- S 61 si , 1-3, 3 v r S <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. PE RIODI PERIOD2 PERIOD PERINCH <br /> P- � B" N,a♦ <br /> P- oN '17i3 9 <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 elevatio d percent <br /> of land slope. <br /> SYSTEM ELEVATION <br /> No <br /> A, l <br /> t <br /> I <br /> I 5 of <br /> 0 <br /> B.m /6 R-0. WT+J <br /> 3- spd« I&b alr3soa <br /> d czea= e o b'a •' <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 /> ADDRESS: CERTIFICATION NUMB R: PHONE NUMBER(optional): <br /> 1{1 3 '604 l V (IZ U41'� �� – n q6 b U-3 S O <br /> CST I <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. ' <br /> DILHR-SBD6395 (R. 10/83) —OVER — <br />