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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, � /� G DIVISION <br /> BO 76 <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: OWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> �• '/ X '/ 1 /TgON/111 E (or V-SOA/ IkIA N u <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> Ir art' Renu m�� ic( .t tir ti � s 6r ,c <br /> USE DATESOBSERVA71 NSMA E <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DE R ONS: E OLATIONTSTS <br /> E : <br /> Residence �2 /r, New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system J (J U l <br /> ONVENTIONAL: MOUND: Itd-GROUNDPRESSURE: SYSTEM-IN-FI LLHOLDI NG TANK: RECOMMENDED SYSTEM:(optional) <br /> ®.S ❑U ®S ❑U M ❑U ❑S [XU ❑S SII (ANy, <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.0915)Ib I,indicate: N 1 Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH 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- `19 or NQGE ` 615L 75 �- 6,V rS <br /> B- a 75r1 '3fl AOM 754 L Lt`r 7� F3N ES. <br /> 11 8�3ij <br /> B- 3 75 Now ? �f„ ` 603 kTs f' 9r F5. <br /> B- Naar 7 � i" `If 6IL51- r542" ( NF <br /> g <br /> B / fl N V6 GkLTS St)" N i S- <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. PERIOD PERIOD PERIOD PERINCH <br /> P- ) 6 9 <br /> P- — \I a 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 /> 1 ) <br /> r 1 <br /> 33(" e I � <br /> I 0t <br /> *ZAP71411� <br /> ssooI N <br /> a>>,r 7DQ <br /> OF <br /> reo� <br /> 1-do,U LAIcE <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(prin" TESTS WERE COMPLETED ON: <br /> MP'1) c, PROFr-� 5-(- -97 <br /> ADDRESS: CERTIFICATION CATIONNUMBER PHONE NLBE�(o �I): <br /> 1Inf3 D ?�1 4 <br /> IyriP30 <br /> O ' S2-T � <br /> CST R <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DI LHR-SBD-5395 IF. 10/83) —OVER — <br />