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DEPARTMENT OFREPORT ON _SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUM,8_N RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCQ,/Isf'. �/ SEPTI %�� ME h' <br /> TOWNSHIP/MUNICIPALITY: LOT NO.'BLK.ND: SUBDIVISION NAME <br /> P W I 'aaj C5m U. 10 a(� <br /> COUNTY: OWNER'S UYER' NAME: MAILING ADDRESS: <br /> L &44 2li` �n -;iS<0 �eviv G�rnfiz. l� S <br /> USE DATES OBSERVATIONS MADE <br /> NO. EDRMS.: COMME/R►,CI/AL DESCRIPTION: PROFILE DESCRIPTIONS: PER O ATION TESTS: <br /> Residence /t / XNew ❑Replace I [�® !s--- <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> CQ_ �71❑� . M�s, ❑U IN G[i US P❑�RE: SYSTEM-INMTANK: RECOM{v1E ENDED SYSTEM (optional) <br /> Percolation <br /> DESIGN RAT S S `Nth <br /> If Percolation Tests are NOT required /A` � If any portion of the tested area is in the <br /> under s. ILHR 83.0915116),indicate: / v Floodplain, indicate Floodplain elevation: AM i <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- .7 a` 9yY/4 > 7a y" l0 San <br /> Aynil 2' 7-2, ISIS/ san4d <br /> B- ? � 9& > V�&est <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 1PE 10 2 P I D PER INCH <br /> Oma ! I <br /> P- No>vL, ��,,, N <br /> P- <br /> P_ <br /> P_ <br /> P__ <br /> PLOT <br /> -P- <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Ind-tate scale or distances Desbe h t e thellori- <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 /> . ---- <br /> of land slope. <br /> SYSTEM ELEVATION <br /> BPI= 7 "Ola kp ° ` 90' <br /> ill <br /> ill9� <br /> i.,t,r ani ��' ,� 3� PY <br /> F � <br /> 9� <br /> 4�scc '3 8�, TN <br /> e�VCaT�an3 ='�(Jv <br /> 13=/3cst�e 1.J�le. . <br /> tlt. i A12 Ajo /3k 11"1 C.A..* Tilt r5 lle4w_e <br /> and do w.¢ ll.o -Ec> / ryhbvYs i,Pl/ z1"a i 5ysfeWar1W .�y ( 35G � <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 /> NAM if1pr int)'. ITESTS WERE COMPLETED ON: <br /> ADD ESS: I _ r CERTIFICATION NUMBER: PHONE NUMB ERIoptional): <br /> o�S�9-73 111 <br /> q CST SIGN TUBE: <br /> Ll <br /> DISTRIBUTION: OriginaTan to Local +thority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10183) —OVER — <br />