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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, -- - DIVISION <br /> P.O. BOX 7969 <br /> LABOR AND PERCOLATION TESTS (115) <br /> HUMAN RELAT(CINS MADISON,WI 53707 <br /> (I LHR 83.090) & Chapter 145) `/J ' 777 ,?7d-a- <br /> LOCATION: SECTION: TOWNSHIP/%VfM161PA� i LOT NO.:BLK. 0.: SUBDIVISION NAME: <br /> ul/4 -!SW/ 3 s/T �iN/R►S! (or)W o N� ,Ul A prit <br /> Cp4UNTY: OW ER'S/BUYER'S NAME: AILING ADDRESS: <br /> U41 4e A — t -e 4v s a4 � <br /> USE VDATES OBSERVATIONS MADE <br /> NO.BEDRNIS.: COMMERCIAL DESCRIPTION: �s� PROFILE DESCRIPTI NS: PERCOLATION TESTS: <br /> Residence I2s�New ❑Replace d,f, <br /> RATING:S=Site suitable for system U=Site unsuitable for system J <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ®S ❑u ®S ❑u MS EU <br /> ❑S ©u ❑s ®U I eb 0Ill / <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.0! indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH 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 /> B- fin I t IoW e °) o "B„(s 3s ” / V Ii <br /> B 3 f� lofts- � � ) �, 6 "B. <f 9a" 4S <br /> ffB- 6T- <br /> `7 97. S' 7 7� b"B< <s 39" tt 31'" <br /> L /� n•S 7 ,— ''B. if a" CsSit ht dS <br /> B- / r� BQh�S 4-r (00 '/ <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD P R PERINCH <br /> P. 1 tl 10 / S"/ / 7 <br /> P O O / 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 dist nces. 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 igs and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION <br /> F ► r e 1.7 S <br /> /C.o o <br /> sc44 <br /> Mn Ica . <br /> N <br /> I � t <br /> r y f <br /> _ . it�vl ra0 ` %xf Yhn t �4 r d �tM ItF <br /> Q i? d <br /> /r <br /> I,the undersigned, hereby certify that the sp sts reported on this form were made by me in accord with the pro edures and ethods specified in the Wisconsin <br /> Administrative Code,and that the data recor and the location of the tests are correct to the best of my knowledge and belief. <br /> NAME (priryryI TESTS WERE COMPLETE ON: <br /> edV. rlef� cr FYllts Q ' a- 9 - ?PSS <br /> AD 110` S � CE RTIFIC-7 NUMBER: PHONE NUMBE- (optional):33 mss-�?661//07 <br /> C$F 61 G <br /> /tel,/ n <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />