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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND RELATIONS- PERCOLATION P.O. BOX 796 <br /> TESTS (115) MADISON WI 53707 <br /> HUMAN RE <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWN SHIP/Md"TCtPALTn�: LOT NO.:BLK.NO.: SUBDIV SION NAME: <br /> u v.s�'/, aq /T3fN/e /jFInr)w QhI4 r ,y�f ,v4 /v <br /> C$RUNTV: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> bUrnte7t 61` — /ren o / -167 J[ rr ,v lu� .fr/Q7� <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: �c�f PROFILE DESCRIPTIONS: PER OLATION TESTS: <br /> Residence [:]New Aid Replace I OJ 3Z�tl/�� <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ®S ❑U O ❑S ❑U ®S I EIS ©U EIS ©U L ivv <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> q If any portion of the tested area is in the <br /> under s. ILHR 83.091511 b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH 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- �s yy. i iuON14Q 78s o-s"e4Cs s '�' 77 "$11 (s /7 = 91* s <br /> 13. 7 t( > B1 0-6 " ec< r i7 " 61,v i7 ' <br /> B3 $ � 3 , 7� b o-s" eUs If " B„<r is"- 86 ” C r <br /> B- <br /> B- <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 PERIOD 3 PERINCH <br /> P- 411 o S' is// / '7/8 <br /> P- 2- 32 jv 0 s- l 1 i, <br /> P- N 0 <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. r <br /> 30 0 Ta prep Lrni�e. <br /> SYSTEM ELEVATION 70 . � <br /> enc • <br /> q6I 37. �? �or,e .. d <br /> SIA FO Icres- <br /> .(e <br /> TN <br /> D">) <br /> I, the undersigned, hereby certify that the soil tes s io ' Y rocedures and methods specified in the Wisconsin <br /> r <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): TESTS WERE C MPLET DON: <br /> 0 Jar-f C_ �" fNS 37 8787 <br /> ADDRESS: CERTIFICATION NUMBER IPHONE NUMBER(optional): <br /> W %e Ls r WI , T-f/ I/ 37 his-f66-yiS'7 <br /> CS T <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />