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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 /> 3707 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIPIMUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> '/ '/a /T3 N/R I N (pr)W U c AIS N <br /> COUNTY: LW ER'SBUYER'S NAME: MAILING ADDRESS: <br /> MM0 c _�W Lo O STWE:1 ,90Y ME SPooOFEIZ W1 <br /> USE DATES OBSERVATIONS MADE <br /> pp��__ NO.BEDRMS.: COMMERCIAL DESCRIPTION: �yI PROFILE DESCRI/P'TI NS: PER OLATION TESTS: <br /> tjkResidence ! �/ Id1 New ❑Replace - 13 - 9 T Z4_ <br /> 1! - OQ <br /> RATING:S=Site suitable for system U=Site unsuitable for system CJ V J O u <br /> CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTE :(optional) <br /> "S ❑U ❑S MU DS ❑U ❑S U ❑S U I Cow- <br /> If Percolation Tests are NOT re uired DESIGN RATE: <br /> p �� If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <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. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> B- (1(7 �� Z 0NE780 0-51311CI5 S'INBN IS ILf to iNM-S <br /> B-� 2 �g (( > ?Z O-S Ul (s 9-19 U Is (') - 7'2-PSN m5, <br /> 280 o- bvoK ' <br /> B- 3 SO 09 .1 . b-IS brJ Is is -S0 80 w4s <br /> Q Q r7 II <br /> B- 0 (J I- 1 -7J0 I3' -2' BNlVns <br /> B- S 72— $7• ri >72 0-SBIk Is 5—IbBPIS IS-• N M5 <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 PERIUD 3 PERPER INCH <br /> P- I PO S I`/1 i I it /I VIA 3 <br /> P- z Ao S 3 <br /> P- �-LL. tjo <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 dist nces. 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 bori gs and the direction and percent <br /> of land slope. 0Kt(j(NAL 7E_-PLH LEN ENT <br /> SYSTEM ELEVATION OW"i <br /> IiWE 1'- `ID' 137' APRoe <br /> $°fie 5 <br /> I BM foo IQ''wN ITS PIfJ5 300' I o� � 3 4 <br /> • Bd2C � ( �' <br /> EAYRox 100'To T N <br /> 4o UNC <br /> IDR VE <br /> 4— <br /> q ,aX lod <br /> �a to S ♦ �� •wet( <br /> aT c�tie <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):R I f�14 00 HoPkTESTS WERE COMPLETE ON: <br /> lin�s <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> (.06,8S R2 Wl 5 3676 115-g66 -`IIS <br /> CS IG ATURE44 <br /> : <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. CV <br /> DI LHR-SBD-6395 (R. 10/83) -OVER - <br />