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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 /> MADISON, <br /> HUMAN RELATIONS SON,WI 53707 <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATIIPIN SECTION TOWNSHIP/hSliW161AAtiTV: LOT NO.:BI N .: SUB IVISIO NAME: <br /> G��/x"' �/ /T 1*11/$I(00 w c �aN � v '1 p p-3 9 <br /> CO NTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> �n . <br /> USE DATES OB9PERVATIOIJS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFI E D SCR IPTI NS: PER OLATION TESTS: <br /> esitlence New Replace D 7 �P/ /O <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND6PRESSURESYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTE :(optional) <br /> SSLAIMSEAL 19S ❑U ❑S ®U ❑SOU d o KJ✓, <br /> DESIGN RATE: <br /> If Percolation Tests are NOT required If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(6),indicate: IFloodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH 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 /> B- 9,y Aj0k) `;;, 7a- D-S _7d " <br /> B-1 7a- . o:r "e< is " 7.�-`' R L�odr <br /> Br 99 -7 o _s-"'S4cr s "- n" dIX <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 PERIOD PERIOD PERINCH <br /> P-_A� <br /> P- <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 bor ngs and the direction and percent <br /> of land slope. q <br /> SYSTEM ELEVATION <br /> 13 <br /> � 7 <br /> •4_ _ r <br /> TN <br /> I, the undersigned, hereby certify that the soil tests reported on th' ,1)r1e in accord with the procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the data recorded and the to - Qe- ' or <br /> �[he best of my knowledge and belief. <br /> 14� <br /> NAM iprin 1: NESTS WERE COMPQLET DON: <br /> d hIC Q t / \ � \ \� �� 7 <br /> ADDRESS: \ ,.'r \` / �) CER lr'.ATIOlq NUMBE PHONE NUMBER(optional): <br /> be <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. ' <br /> DI LHR-SBD 6395 (R. 10/83) —OVER — <br />