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DEPARTMENT OFREPORT ON SOIL WRINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, � DIVISION <br /> 13.0BOX <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSSHIP4464ftt"'ArtTP. LOT N .:BLK.N .: SUBDIVISIO NAME: <br /> Sw '/S' '/ /3 /T o N/RJS j(or)W 'c- /s' ti N .V / <br /> C UNTY: OWN1,,.H'S BUYLW5 NAME: MAILING <br /> ADDRESS: /!, A A / <br /> PM fi_r(A <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: I <br /> IPROFILE DES R TI NS: PERCOLATION TESTS: <br /> Residence I'DL XNew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system 7 7 '7 T ✓ <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:[SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ms ❑U I ms ❑U INS ❑U ❑S AU I ❑S CU 1 c C VL/ <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(50),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 /> - i 46 w e o <br /> B- 90 1 Q a `' 7 v 6 `'.3k 4 r ,o..� l! nn <br /> B- Q° 101.(0 I ' 7 ? 0 &e,g' s if C l 6 " r cf T <br /> 13- <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 PERIOD PERINCH <br /> 0 I oa- d � 3 -.5— <br /> P- o O s / 7 <br /> P- <br /> P_ <br /> P= <br /> P_ <br /> PLOT <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 ° `" <br /> NaTe � / I/LSI (D64 ofi7 <br /> 7ES4- <br /> PrssPet airc)[ �iS ow`I 4!` e'4 <br /> ®VOm0 9 Ner'7i.lPtt J'C <br /> Or,. Qcrfa . on 'ocnd <br /> 3 � c7�N <br /> Supe <br /> ' Os i 1ltn�� <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with t 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 /> dp k Y`1 I ' r y Y- S, 5� <br /> A R SS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> W--e �1 r �r ` 4 - !T, 0,P 3 �s 9C16- 9"--S <br /> CST GNAj,URE: . � <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DI LHR-SBD-6395 (R. 10183) —OVER — <br /> tI <br />