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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (ILHR 83.09(1) &Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBD VISION NAME: <br /> y Sc y, 30 /T4( N/R ISE (or IN 6uj t ss ic,25- 1 15T H v A af)` tEZ� 79e2c— <br /> COUNTY: WQ NER,S BUYER'S NAME: MAILING ADDRESS: <br /> 6,11?ucTr I GRe-c-oma 3q TttikD 4(JE- <br /> USE I DATES OBSERVATIONS MAE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: I PROFIL DESCR IPTI Q NS: PERCNOLATION TESTS: <br /> Residence <br /> Al alk- ❑Replace S� a _ <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVE(N�TIONAL: MOUND: IN-GROUND-GROUND -IN-FILLHOLDIIN�G TA K:RECO/MM//MENDED SYSTE :(optional) <br /> J ❑U ®$ ❑U ®$ ❑U ®$ ❑U ❑$ 6DAj 71 U L <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)lb),indicate: IV Floodplain, indicate Floodplain elevation: No <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, CO OR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> C14 <br /> B- I i,!p" K)o uE 7 Old is, T_S, 3qr�N!FS, <br /> g �7if l Ad'6" Nora ? 57" C SL w,i�. 3O" 2vS xI >3N1'S.. <br /> B- 3 �7 !®tl it No+ii% <br /> 27" �'� ��. ��.TS . Via" Z1�7s , a L3u rs <br /> 13 b3" l oo a No N✓ 7 43 S� 6Lt 5 . 31 " j2 �g P�h S' <br /> B- 6- G9-4" /Jo 75? b' S464 -1-5, 50` RFS 1 ` 13N�S <br /> B- NofF A[lExti STLM1 kJrLG ✓NGo /.)le B a- -4 - �,- AT 5,15Z-vi QW.ac <br /> PERCOLATION TESTS <br /> TEST DEPTH I WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES I AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD2 PER 3 PERINCH <br /> P- a �' otic a `l a-�l 6 x s <br /> P- 53" P al= �-. y t <br /> P- <br /> P- <br /> P- NaTE.' g> _ I 3 o� -Xls>f;v� a Sos`L A[C cis H <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or dist noes. 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 ®r Ji9" 3vQ[✓vcgr>rs LflKE <br /> rCb�o" <br /> t � <br /> Zo ' .QT GR 9DE <br /> S1Al'� 45'— Hz I <br /> .BCG4 I r <br /> I via & L.L, <br /> +,I <br /> a TPI <br /> i <br /> `?Klvr=' j <br /> / <br /> B✓RL/bG4m�? 4MAle R.Og17 <br /> /Wf�N <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and ethods 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 /> iv4k/) _p ' g 2- & <br /> ADDRESS: 7 wr _ CETRTIFINC,AAI�E:NUMBER' PHONE NUMBER(optionall: <br /> !3e l7J�Q <br /> CS <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />