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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.D. BOX <br /> 7969 <br /> MADISON, <br /> HUMAN RELATIONS SON,WI 533707707 <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> iiiii <br /> �S) /BS' N/R/7 Io0W neat <br /> UNTY: MAILING ADDRESS: C <br /> lum\ - I NN c ..3/J9 Lk, RQ l 1Zr_N <br /> USE DATES OBSERVATIONS MADE <br /> NO.B,,,: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: STS <br /> Residence [:]New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> 2s ❑u ❑s ❑u ❑s ❑u ❑s ❑u ❑s ❑u <br /> D <br /> If Percolation Tests are NOT required 'SIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.0915)Ibl,indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUISDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED /EST./HIGHEST TO BEDROCKK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 , 1d_ / ,, 0h e �_��u SL.. .,i641S4. "&L5 <br /> B- <br /> B- <br /> B- <br /> B- <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. p RIOot —PERIOD 2 PERINCH <br /> P 3 <br /> p- <br /> P- ci1Z <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 t air location on the plot plan. Show the surface elevation at all borings and the direction and percent <br /> of land slope. 1 <br /> SYSTEM ELEVATION 7 'C 41 <br /> oi— — <br /> r <br /> i <br /> 3Bc <br /> Ps <br /> 0y_ + UR'4.IJrL r"r ;iY.¢`LF ) cr .d <br /> v Y� 12 Y ti <br /> I err �I <br /> IN <br /> r <br /> �r 33 (gtn t <br /> i <br /> vel Lac:iG.�L - <br /> r <br /> ,1 r <br /> l <br /> 1 i i , <br /> - - 53 <br /> I,the undersigned, herepy certify that the soil tests reported on this form were made by me in accord with the procedures and m thods 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 /> i2 _ 1 1 / C11A <br /> A-EYOR'ESS: CERTIFICATION NUMBER: PHONE NUMBER <br /> (optional): <br /> Du, V <br /> CST SJGNATURE: <br /> DISTRIBUTION:Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHRSBD-6395 R. 10/83) —OVER — <br />