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_,Er'AR I MENT OF REPORT._ON. SOIL,_BORINGS _AND SAFETY & BUILDINGS <br /> DIVISION <br /> INDUSTRY, <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.09111 & Chapter 145) _ <br /> LOCAs"ION: SECTION - TOWNSIIIP!Mt1NICIP I.tTY LOT O. ELK. NO.: SUBDIVI y NAME <br /> PE 1/ 3 /TItIll/R/6@Inr)w c /F 41 7 _—. Pi41 L� <br /> C UNTV: OlW�N ER'S/BUYER'SLN�A1M E: MA LING AD/DRE�SSS t <br /> DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL UESCH�PTI NS: A N TS. <br /> _ RO I <br /> Residence— h — )New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system N <br /> FON <br /> NVENT!UAL: MOUND: IN-GROLJNUPRSSSURE: SYSTEM-IN-FILL HOLDING TAN K: RECOMMENDED SYSTEM:(optional) <br /> ❑ S auToS ❑u EISLIQ ❑S au ❑S ❑u <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83 091511 h1,indicate — Floodplain indicate Floodplain elevation: <br /> __ _ <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERIVtE DD EST. H'tI H/BEST TO BEDROCK IF OBSERVED (SEE ABOB`RV.ON BACK.,)p <br /> B- ' /dv /0 J I �0/V 1... /d V 7 ,ISL /S 3u „rC_ a v, tr y 1. S <br /> B- <br /> B- <br /> B__ _- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATERIN HOLE TEST TIME DROP IN WATER LEVEL INCHES RATER INCNES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-Mi N- -P RI— _.._ PERIOD P RfS6� <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 B o^ a <br /> �Scq (t I ''= q0t <br /> �M <br /> --------- o , <br /> IL <br /> TN <br /> 7 �o`1A <br /> a pw•cllin� � 4afi-c <br /> Q� <br /> c < <br /> I, the undersigned, hereby celnfy that the soil tests reported on this form were made by me in accord with a 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 @rJJind: TESTS WERE COMPL3TED ON: <br /> �� /'/'C" I � 1 �h f CERTIFICATI N UMB R: PFONE NUMBERInp tional): <br /> ADDRESS. <br /> Vr-P S 7 r r (.s� s—r --- — --- --- 7.r--P a - P <br /> — C�,P NA URE:` s <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. (" <br /> DILHR-SBD 6395 (R. 10/83) tis,f a4.r /7/ /�9"a3'o/ OVER -- 20- v <br />