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DEPARTMENT OF PORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, _ DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O.MADISON WI 7969 <br /> HUMAN RELATIONS <br /> ULHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION y� TOWNSHIP/ LO,TNO.:BLK.NO.: SUBDIV1SSION NAME: <br /> 1i�S �� /T yvN/ (or)w G / / h <br /> dC UNTY: OW R'S/BUYER'S NAME:�•- MAILING ADDRESS: <br /> C7 1\4 a rThc 0 2q 14 •,, b /t 4 u M Zr nn <br /> USE DATES OBSERVATIONS MADE <br /> IIpps� NO.BEDRMS.: COMMERCIAL DESCRIPTION: rs�- PROFILE DESCRIPTIONS: PERCOLATION TESTS <br /> L7� : <br /> {.�Residence '1 New ❑Replace J-- <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> (CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FI LLH0 L DI NG TANK: RECOMMENDED S YST E M:(opti ona l) <br /> ®S ❑U I QS 11UDSEA 111SXU1E1SZU1 cow v <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 63.09(5)(b),indicate: I Floodplam, 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- t fo to/. S oi� e > 8 0 _ ' Bn +mr//df ,f /s' <br /> t11, 3 ' t 7Fqi S''8:, ed / �� eds- H� CS <br /> B-3 vt. ( ' ` > ^ .I 'B., n., fd f �S/ '' R . d �" 6 / " of C S <br /> 13-1. nor '` Y"'Bs, ,.,, <br /> kit <br /> BB-- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCCH�HE�SS AFTERSW,ELLING INTERVAL-MIN. PERIOD 1 P ROD 2 P RI D PER INCH <br /> r- <br /> I Y.7. I 0 -� S _ 7 S` <br /> P - <br /> 4 P --- --- -- — --- <br /> °__ <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 Q <br /> �rrC. r <br /> SCq ! ff, y0 I ort <br /> wYST Okay ( 4r- _ <br /> v <br /> T N <br /> U rD 2 <br /> v y � <br /> ��� • a Tw ,n1 a "/i cl <br /> ffF_r,e r6 <br /> ' n . <br /> 1, tike undersigned, hereby certify that the soil tests re orted on this form were made by me in accord with the procedur s and methods specified in the Wisconsin <br /> F,de�, rnistrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and )elief. / <br /> 4w,W ///Q ' <br /> NAME iprint): ]T ES'TIS WERE COI PLETED ON: <br /> —._— t�__ <br /> ADDRESS: r.—„ ` CER IFICATION UMBER: PHONE NUMBER(optional): <br /> _� <br /> c�sy,NA uRE: <br /> DISTRIBUTION: Original and one copy to Local 4uthorlty.Prepert•; Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) -OVER — <br /> -aeca.. <br />