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INDUST N".--ENT 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 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/ LOT O.:RLK. 0.: SUBDI;VISIO NAME: <br /> S'w'/a eVEY 33 /T'�A/R �6l cnr)W 0 q ,U <br /> COUNTY: OWNER'S BUYER'S NAME: , MAILING AUIJH <br /> p 01 <br /> USE DATES OBSERVATIONS MADE <br /> Ip( NO.BEDRMS.: COMMER IAL DESCRIPTION: IPROFI�E CRIPTIONS: P7 ZFlrl NTESTS: <br /> yy Residence ? New ❑Replace //rj p/ � G// //D� <br /> RATING:S=Site suitable for system U=Site unsuitable for system 7 C G 7 O <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEMI(optional) <br /> ®S ❑u ®S ❑u NS ❑u ❑S ©u I ❑S Kul ti v <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> 9 If any portion of the tested area is in the <br /> under s. ILHR 83.0915)Ibl,indicate: 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 A BRV.ON BACX.) tr <br /> t <br /> B gD g9 II > �� 7ft I= <br /> y.» r S- - 6 <br /> B-3 <br /> II a .T 13C/ r S t 'y•,�t <br /> Q o q9 �. > � � <br /> B--7 7� / " > 7S <br /> B- <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 PERIOD2 PERI D PERINCH <br /> P- / 30 <br /> P- a 31 nro <br /> P-3 A ty YU d 10 T14-1u// 9 <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 /> SCOL e, / ti, W Bone A <br /> �\\ D <br /> �a p-T �N <br /> � I <br /> _ I <br /> 1 _ •a ���ti N of L 7:u I�Fr•c <br /> �p <br /> 13 <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 /> odrrfc / 1 b�t-o iK f � b <br /> ADDZ� 6/ CERTIFI ATIO NUMBER: PHONE NUMBER(optional), <br /> r7tirt- 417s466- oxl` <br /> CST NATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. `—�— <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />