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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 83.0911) &Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MtiWi6iPAt4FW LOT NO.:BLK.NO.: SUBDI ISION NAME: <br /> u� �/ uE 1/ A9 /T y/N/R/sN(or)W s wlss �/ N� N <br /> CBUNTY: Tr OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> Durn Y /1 9�a c c Gr Tl` 6?1 L/ Ba ¢a <br /> USE DATES OBS RVATION MADE <br /> NO.BEDRNIS.: COMM ERCIAL DESCRI PTION: PROFILES RI PTIO 5: ER DILATION TESTS: <br /> Residence [:]New Replace 9 - /0 -0 <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PFES SIII E: SYSTEM-IN-FILL HOLD I NG TANK: R ECOMMENDED SYSTEM (optional) <br /> ®S ❑U ©$ ❑U IS ❑UI ❑$ ®U I ❑$ ®U e 0 uV <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(5)(b),indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORINGTOTAL D PTH 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 E ACK.) <br /> B- I 9g 76. 7 Nefu-P 7 `18 e -s "e14r s '_ /8"47- 14 .,» <br /> B- � 71. 90-60en 4S 6 "- /6" A7`6 "a?r ! 73" V C 5- <br /> B_ S � � 1f 0-61,eh (s b ;k0 4ft% .ds ao ' " y CS <br /> B_ <br /> B- <br /> 13- <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 P R PER INCH <br /> P. 1 N ?. N a 3 }— /.T.- /I. �- <br /> P- 1- a3 w0 3 Ari <br /> P- Iva <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 4 Sf gtt4//( 43 M left <br /> SCat_e / ": 4/0' f0rr-t '• <br /> sT�, <br /> OJT—_ <br /> TN <br /> A_l <br /> I <br /> ti <br /> n j 0 'ro Lit <br /> I,the undersigned, hereby certify that the soil tests reported on this�orri were made OIL in accor with the procedures and r iethods 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 COMPLET DON: <br /> r <br /> o I o- ff fns - /0 7 <br /> ADDRESS: CERTIFICATION NUMB R: PHONE NUMBER(optional); <br /> cu.� fo ?7Yr SY FF3 � 7 IIs96je -Wa•7 <br /> OLD- <br /> S G ATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> D I LH R-SBD-6395 (R. 10/83) —OVER — <br />