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DEPARTMENT OF REPORT ON N SOIL BORINGS AND SA ETY & BUILDINGS <br /> INDUSTRY, _ _ DIVISION <br /> LABO -- -UMA ANDN RELATIONS PERCOLATION TESTS (115) MADISON,WI 3707 <br /> H <br /> HUMA <br /> (ILHR 83.090) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/UI 1r'1lL2A1 1. y: LOT NO.:BLK.NAO.: SUBDI VISION NAME: <br /> /� �� �� �3 /T�e N/R /fit(or)W Q U ' L Cr' —ri d/ /� /t <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING 4t` A9DR�° �f <br /> ,RnC� vrz- t c-tP rf <br /> �m WrS , bS i`p f-' <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> ❑Residence M A I <br /> [--]New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system P <br /> CONVEccNTIONIA''L: MOUNccD: jI_1q-_G_ROUNccDPRESSURE: SYSTEccM-IN-FILLHOLDIIcNGTANK: RECOMMENDED SYSTEM:(optional) <br /> �J �V �J �� �J EU FJ �U �J 0U <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> 4 If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(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 QBSfRVED (SEE ABBRV.ON BACK.) <br /> C F,' <br /> B- q �vorv,� got" D -re"� is 10'-' 1F" DiraN'L.s i�"-9ah eti ",�►r�s <br /> B- ^^ qo""- vY " (3w 6,, rJ., L C yr, t� <br /> B- 0 " 0-1(D " Sci 4r to5= 99 " Gy a A-s7 ' c� <br /> B <br /> y " ' }- <br /> 1N E S 37 r, <br /> �� �MlYH°o <br /> B" Q / L)iScCN /lntVS' <br /> Y <br /> PERCOLATION TESTS S.4L <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIoo2 PERIODS PER INCH <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 /> JU0 cc A,+ o C 4,ry a 1-0n T - act4 , c4r;lT 11eft 'S.x S <br /> Tq $ Lj <br /> � TN <br /> Cleve JA40'� Wt0�rcrrsPcE,( <br /> C 6t 0 r t Al"*h L4 014 f XP ,1- Ti II/C�T i- c i i/i * j° e <br /> �y S-yt�",„ L- n kn SW Aj <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 /> NAME (print): h TESTS WERE COMPLETED ON: <br /> 0 4 14 C ft I + s -- <br /> ADDRESS: ` 8 / CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> C IGN/t,TU E: � <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> "r)-6395 (R. 10/83) —OVER — �� <br />