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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(7) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> '/a 1�- '/a /T ON/R 11 (nr)W Mi_App Sl NpPxDdxvs ridC�e P/Ni� <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> w .0 r Co <br /> urfrq TPLavLE <br /> USE I I DATES OBSERVATIONS MADE <br /> �I NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS:TIONS: PER OLATION TESTS: <br /> RResidence �'f New ❑Replace I �.- -� �� g' `-5 F7 <br /> RATING:S=Site suitable for system U=Site unsuitable for system v <br /> CONVENTIONAL: M®ND: ❑� IN-GFiOU� P❑�RE: SVS❑TEM-I®ILL HOCEDING®NK: RECOMU I MENDED SYSTEM:(optional) <br /> If{{LL�\PPeerrlJcoollation Tests are NOST required D®ESIGN RATE: S U If any portion of the tested area its in the <br /> under s. ILHR 83.0915)16),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B-/ �� gFl.y Non/E ) $s O- 7 BIK imed s 7 - SS SrV 01" s <br /> Bz n 973 11 r' tt l � <br /> B-3 II 17. 6 '' It Blk need s 6 - YS pry cured s <br /> B Ir 57.7- Ir 0' B/k PI s 7 - 8S BrAi i-feats <br /> B- S II �6 9 rr Ir Q ' $ B/k ine.d J $ I3r wfcd s <br /> El- <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 PERIOD PERIOD 3 PERINCH <br /> P. _._ uo 5" l i I YI /8 3 <br /> P- T 9 /' 3 <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. ppyL p 3C4LE 111% elo' EAC,5r &)Ael McY-eJ <br /> SYSTEM ELEVATION S BorE • Bn /60 Alq/L /N BASE OF ALckA/us <br /> o S "� <br /> 03 <br /> T N <br /> • <br /> 3 P'gT a id8 <br /> T <br /> S5� <br /> Cart- Lime 7`l7 <br /> I, a 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 /> os 8 - ;LS -S1-7 <br /> AD RESS: CERTIFICATION FICATION NUMBER: PHONE NUMBER(optional): <br /> 7—r w's_ s �9 Y31-71-71 4 - / <br /> C N TU E: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. ✓ <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />