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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, - DIVISION <br /> P.O. BOX <br /> LABOR AND <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,W153707 <br /> 3707 <br /> (1 LHR 83.09(1) & Chapter 145) <br /> LOCA ION: SECTION: TOWNSHIPOO: SUBDIVISIONNAME- <br /> L Y / /TY8NRkV(or)w '0 . 04 <.._4l <br /> COUNTY: <br /> OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> rn t C Alis �-er BPd+�1�J Tr Qu / 8 S- '00.+ Z. t+. :. s `/ <br /> USE DATES OBS RVATIONSMADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: 11y���'' PROFILED SCRIPTIONS: PER O ATION TESTS: <br /> �esidence y�•tvew ❑Replacer <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDEDSVSTEM:(optional) <br /> 19S ❑U ®S ❑U pcS ❑U ❑SQU DSU <br /> 20 •✓ ✓ <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)11b),indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH 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- J I 00io /o;). PO 0 3"B4 ( r A0 "R< s 37 '' Mtiis <br /> B-�- Fj? /o `` $ 0 3 " do, lr a)0" if S7 " if MtIs <br /> B_ t r� o > '7J_ a"e•► ill rill S- <br /> B-S- <br /> B-S 7a X"es, 3o " RCr YO <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. PER10 1 PERIOD PER PER CH <br /> P- .�s /U C) (o 1111f, o1 i i a- <br /> P- �l- n10 �� a7 � a3 y arae <br /> P- S/8 a / a .3/ <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 I. 9 P r ► c • <br /> BeI.r- Id <br /> � � r <br /> NQ; l f#j 8ti : e ° &0a '6F7- <br /> `6 d e, E_L� <br /> Q M 10 a <br /> �C SSu r <br /> Sc4 ( e TN <br /> "17 LA <br /> d <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 /> NApME(prr nt): TESTS WERE COMPLETED ON: <br /> ADDRESS T ( r w ; C/ jr r.> CERTI FI'T�N NUMBER: PHONE NUMBER I'��Tonal): <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />