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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 83.09111 & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK NO.: S BDIVISION NAME: <br /> (0 1/Vie 1/ /T O N/R/4 9 (or)W 0 /-4A/9 (/ALS /UERR11i65S <br /> -COUNTY: OW ER'S BUYER'S NAME: MAILING ADDRESS: <br /> D COV &ATVNC <br /> USE DATES OBSERVATIONSMADE <br /> NO.BEDRMS: COMMER IAL OESCRIPTI ON: w ❑ PR ILE D J TI NS: ER ATION TrIESTS: <br /> y�Residence �7 /L__ NeReplace / <br /> RATING:S=Site suitable for s-y-stem U=Site unsuitable for system U <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM (optional) <br /> S ❑U t4s ❑U ®S ❑U ❑S U ❑S ZU Iu aA� <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)Ibl,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 ACK.) <br /> B-/ 'I'D•I Nd NE 7 �o 0'3/ R AJu/s <br /> 13- 2 `) 7S--z '1 0-581Meds S-36Kmrds3� go �NA74c1s <br /> 13-3 11 100' s 0-6&"dS 1;,-33 EA?ed.S 3 -db tau reed r <br /> B- o-U -z9 2 863N e1 <br /> 13- <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 PER1002 PER PERINCH <br /> P- s t% yL <br /> P. 1r, 11 1 <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 thelot plan.. Show the surface elevation at all bori gs and Ate direction and percent <br /> of land slope. { aC y 6rM L.E 1'r s 4/6' C)(te WHERE NOTED <br /> SYSTEM ELEVATION J A G BoRE IN loo PAlt,IN WTI F I V')ACK 005 <br /> oPo.S�D <br /> T N <br /> A, <br /> � Z $ <br /> u • <br /> (moo{ <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and ff 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 /> NAPE(print): TESTS WERE COMPLETE ON: <br /> I <br /> teo Lc' <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> Cu,e.LzTt wis S 8?3 C7N(i 7 ?ls �G6 Yir7 <br /> c �y <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> D I LH R-SBD-6395 (R. 10/83) —OVER — <br />