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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, . DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 576 X 3707 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME- <br /> NE <br /> AME: <br /> NE '/ Nw '/4 35 /N N/R15 E for R 11 p �; <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> u 'WEIT RALN SKOC I L I S E 7n 91 81,FAUt MO. Sq Io <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: IPROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> ®Residence 'L �_ ❑New ®Replace Iluu,,O= <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ®S ❑U EjS ®U ®S ❑U [:]S ®U ❑S ®U N1 <br /> SIGN RATE:E <br /> If Percolation Tests are NOT required DIf any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(6),indicate: r�_' I I Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPT 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 /> B- 1 80 118 .6 NONE 430 0-4 Buns 'f-% 8NAb 5b-I evms w9r <br /> B-2 '12 91. 1 NOW_ >�2 0-SDI Ms S -yobNms 14 -72ISJMs W5r <br /> B- 3 '12 0 0 -5gl ms 5 'I2 B-j M 5 <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIoDI PERI002 PERIOD3 PERPERINCH <br /> P- 1 2 NO 5 <br /> P- 2 2 NO 52 3 <br /> P- 2No '7/y /-5/9, 3 <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 /> GR't�N Q <br /> 1 3 <br /> ♦�H/oo,UALiuft+ e� L4 <br /> F I2�# r.{013 AV0 ' <br /> U*1l <br /> BLAS <br /> GARAGE <br /> I,the 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 /> 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 /> IC ) Hon-lo 0-1 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUM13ER(optional): <br /> 5 1 �1$ti 670 <br /> CS I ATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />