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DEPARTMENT OF REPORT ON SOIL -BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNS HIP/Mb"+G+Aif=ET-Y: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> Sate14 Ale 1/ -,zD /T VN/R/ E to >ELS <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> e� /P ScNAFER /a SS /oaIVD e L06�1dE SS � <br /> USE DATES OBSERVATION MADE <br /> NO.B^EDRMS.: COMMERC IAL DESCRIPTION: ,,�/ PROFILE ES RI/pTIONS: ER OLATION TESTS: <br /> Residence I— /1� /f ILYNew ❑Replace I C���/r-yy� <br /> �/ 1F'f- <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-INFILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> DS RU ❑S_ ®U ❑S igU ❑S ®U k'S ❑U C7>4L. lljl& a zA44k <br /> If Percolation Tests are NOT required DESIGN RATE:J If any portion of the tested area is in the f <br /> under s. ILHR 83.09151(bl,intlicate: Floodplain, indicate Floodplain elevation: /I l,4- <br /> PROFILE DESCRIPTIONS t <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 ISEE ABBRV.ON BACK.) <br /> B- 113 S 7 7 7" s/ " s a " �,, <br /> B 3 /OD. ND E -;L L'a/s r 5/ 6" s/�ead x MOT <br /> B 3 IM,2641 AMAlir } /o"B/s/ / s/t✓ d P 2ts" e. d <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 PER1002 P If 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 NA-- <br /> �C'EAJPP <br /> BM - &7-MM OF siorN6 <br /> NE e,,1r F_R of HCOsE <br /> ac <br /> TN <br /> 30 By <br /> N�us� //acpi�lG 7XaN,� roP,,�>as' <br /> FRoM !✓Fc�- <br /> FROM Hul-"E <br /> f aB3 660` —� <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): TESTS WFR.F COMPL IV <br /> ED ON: <br /> /(15 S t3EL '7L,5–h'$— <br /> ADDRESS: CERTIF CATION UMBER: PHONE NUMBER(optional): <br /> -3 3 3 - d <br /> CST SI <br /> � <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. 4 <br /> DILHR-SBD-6395 (R. 10/83) -OVER - <br />