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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, - DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 7969 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSH IPI LOT NO.:BLK.NO.: SUB VISION NAME: <br /> S 1/ 4)J/a /T aN/R �E --,)W 07+C Qi as X]Vr- 0Q, 1 <br /> COUNTY: OWNER'SB YER'S NAME: MAILING ADDRESS: n <br /> B !-nt r.//- t/ �� K 4 a 7 Al U Al 0-e 4U. N a frir 144. 3-53 <br /> USE DATES OBSERVATIONS MADE <br /> I�(Residence NO.BEDRMS.: COMMER IAL DESCRIPTION: fPROFI LE DESCR PT IONS: PERCOLATION TESTS: <br /> � ❑New El Replace IL <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FI LLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ❑S ❑U ❑S ❑U ❑S ❑U IDSEA111SElul p :I v <br /> If Percolation Tests are NOT required DESIGN RATE' If any portion of the tested area is in the <br /> under s. ILHR 83.091511b1,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- 1 -7 W7 > 7 } 0Bn � r 4/ • 10r8� inl .a�r l°``7l " � <br /> B- <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBEP INCHES AFTERSWELLING INTERVAL-MIN. IOD1 PERI002 P R PERINCH <br /> P <br /> P- <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 borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION <br /> 7il"ia <br /> n 'fP w< T N <br /> 4 8 0 <br /> I - -� ff6W <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 s ecified 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 /> NA (pri t): ! TESTS WERE COMPLETED ON: <br /> Nr <br /> J-et- rc 7- , F—& F <br /> ADDRESS w CERTIFICATION NUMBER: I PHONE NUMB ER(optional <br /> '?'S 866' <br /> C IG ATUR <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-8395 (R. 10/83) —OVER — <br />