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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOF, AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> ((LHR 83.0911) & Chapter 1451 <br /> LOCATION: SECTION: TOWNS HIP/A4WA16+P*tr7 Y: LOT NO.:BILK.NO.: SUBC IyyISION NAME <br /> sw 1/ o N 0/ rT <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> r F-� 09 <br /> USE DATESOBSERVATIONIS MADE <br /> NO.BEDRNIS: COMM ERCIAL DESCRIPTION: IIS�zzrr PROFILE DES (PTI NS: PERCOLATION TESTS: <br /> Residence A"1 New ❑Replace ,G / �O <br /> RATING:S=Site suitable for system U=Site unsuitable for system (� <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTE 1:(optional) <br /> MS ❑U ®S ❑U ©S ❑U ❑S ©U ❑S DU d0Avv. <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 PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, C LOR, TEXTURE, AND DEPTH <br /> NUMBER DEPiHIN. ELEVAT I ON OBSERVED EST.HIGHEST—TO BEDROCK IF OBSERVED (SEE ABBRV ON W.K.l <br /> O_V "5 LCr U'� y1" 49nt 1J - 3o n 6r•nr <br /> 13- 1- 80 q f, 17 it ;> t0 6 r._ 80 ., <br /> D-S" gclr - a4 ' B,u< r a6 - n t4 L <br /> B-k/ 80 `I F. ( " 3 80 " 8 , d s <br /> 451 S' S-"_ -, " BA Lr y h re o�c <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. PERIOD PERI002 PERIOD PERINCH <br /> P- 1 3 /� o a -Slrf a l/// - c <br /> P- 3 4- / a <br /> P- io / a3 / s <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 boi ings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION <br /> p rd q 4 e / 1Z L/0 ' P rC • <br /> 'e0a4 11 r r t N 0 r`e a 6o r--,- <br /> 0 113 <br /> AP q i Z N 8 f Ie q !a R'" o f/r <br /> ism t0 o D N <br /> 00 7- <br /> o ' <br /> • 4 <br /> II , 3 <br /> YVI Q h <br /> I,th 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 /> Adm istrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> NAME liar tl: /.�. (,... TESTS /WEER COMP T D ON: <br /> o �le f_)C / 1 0 /I l'e S /V <br /> ADDRESS: CERTI FI ATIO NUMB R: PHONE NUMBER(optional): <br /> Cv�e S �r w '. (U37 pis f66- rr7 <br /> CST 51 G ATURE <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DI LHR-SBD6395 (R. 10/83) —OVER — <br />