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DEPARTMENT 06 REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> 19MgN,-RE ATIONS MADISON,WI 53707 <br /> w ,,x,Z C,SM V ;� /j�l (ILHR 83.09(1) &Chapter 145) <br /> LOCATION: SECTION: I TOWNSHIP/MUNI IPALITY: LOT NO.:BLK.NO.: UBDIVISION NAME: <br /> 1/ 1/ Z ( /T3?N/R/8E (pr)W <br /> COUNTY�:y-}� MAAILIINNGADDRESS: (at L- y Zb- y 4 57 ,T3'0 BZ- <br /> /F <br /> USE DATES OBSERVJ LTIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: r{� I T ONS: A TESTS: <br /> Residence /V6 }Gy New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system to <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ❑s ®u as lZu ❑s ®u os ®u I ❑u <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> q If any portion of the tested area is int is <br /> under s. ILHR 83.09(5)(bl,indicate: '—" Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNES ,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.RIGHE TO BEDROCK IF OBSERVED (SEE ABBR .ON BACK.) <br /> Sly ?Jr <br /> B. <br /> B- 3 S� 9/. /G- zz-Qa.s, d. <br /> 9 i z <br /> r <br /> B- <br /> B 3 o-G oK ��l b -/6 ;' d'n /G -z3 ^Qn.3, <br /> p -T -Z9 ' : .V <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 P PERINCH <br /> P- <br /> P. <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. <br /> SYSTEM ELEVATION <br /> D 7 `- y t L 3 <br /> t6 <br /> 2 T N <br /> �. f< <br /> ,wo30 <br /> ' <br /> 34'-7 1J �c?.e_ 2 a_ <br /> z <br /> J l.7, <br /> gp y�yy 1 . <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures 3nd 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 be let. <br /> NAME (pri TESTS WERE COMPLETED ON:p. / <br /> ADORES CERTAFICATION N BER: IPHONE NUMBER(optional): <br /> U(ysi Al- C l.✓, sVeJ 3 37 0 ZI-re12 -'r-y5,/e <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) -OVER - <br />