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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> HLABOR P.O. BOX 76 <br /> UMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/Ividj dfi§ oii +FY: OT NO.:BLK-NO.: S BDIVISION NA E: <br /> � '/� '/ 7 /T`�ON/Rk L, f lQr 3P — dzal),_5 A/tr/ �%lrs <br /> CONTY: MAILIN ADDRESS: <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: 1PROFILE DESCRIPTIONS:1PIERCOLATION TESTS: <br /> Residence ❑New ❑Replace O / <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ❑s ❑u ❑s ❑U ❑s ❑U ❑s ❑U os ❑U <br /> A <br /> DESIGN RTE: <br /> If Percolation Tests are NOT required DESIf any portion of the tested area is in the <br /> under s. ILHR 83.0915)Ibl,indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALDEPTH 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- — n)61_7aS� Q — �ii .J' <br /> B- <br /> B- <br /> 13- <br /> 13- <br /> 13- <br /> PERCOLATION TESTS <br /> LTEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RAPES <br /> ER INCH <br /> f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI D2 P <br /> P- <br /> P- <br /> P. /J <br /> P- <br /> P. <br /> P_ <br /> PLOTPLAN: 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. /✓�F jCC�� /' VO' PvoI - wher(f <br /> —z—_- —� -1 <br /> -- <br /> ro>(. Co 0 <br /> c I <br /> ItN1 <br /> Y �1 <br /> ` r 1 <br /> ra�irnakl <br /> I, the unc Drsigned, hereby JJcertify 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) ITESTS WERE COMPLETED ON: <br /> lkwt /& v <br /> ADDRESS: CERTIFICATION NUMBER: P ONE NUMBER(optional): <br /> -5Y3 <br /> CST//S''IGNATUR E: <br /> Cwt <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. Ll->61 <br /> DILHR-SBD6395 (R. 10/83) —OVER — <br />