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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, _ DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVI ION NAME: <br /> NW <br /> Y+S�'/ /T- UN/R&P(pr)W a' " k('00, PiNGs <br /> COUNTY: OWNER'S BUYER'S NAME: MAI LING ADDRESS: �A <br /> UN( 0� - 13 ' b' PN <br /> USED TES OBSERVATIONS ADE <br /> NO.BED COMM R A DES RIPTI ON: CCxx PR N A TS: <br /> Residence 2 1 New ❑Replace _. /' _7 -./'7—if <br /> RATING:S=Site suitable for system U=She unsuitable for system / <br /> CONVEpNTIONAL: MOUND: IN-GROUNNIIRESSURE: S STEpM-IIf�IN-FILLHOLDING TANK: R ECOMMEND ED SYSTEM:Io tional) <br /> ®S ❑U ®S ❑U ®S ❑U ❑$ ILUU ❑S ®U /J r ~DZ. <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> 9 If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)161,indicate: '� Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOII, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHESj�- TO BEDROCK IF OBSERVED(SEE ABBRV. ON BACK.) <br /> r-7— <br /> 11:1)Z b� IUtaiI RY I/f. <br /> ' 7? 7t - MY 35 - 7 A?Ai <br /> Q - 7 8r-A) <br /> YnHt('zdd5 s <br /> .. t n E ILs <br /> 731 <br /> rt lr l� <br /> 11 <br /> B-S `' ' Z 1i 0.6 - 2- 9 r 29- ;,,i ed <br /> 13- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER L VEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD2 PERIOD PERINCH <br /> P- <br /> )° _ t ' 6 <br /> P < „ 77/ <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 distant s. Describe what are the hon <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. 7trL C/ LLF— rrr� tl0' eu e-e,,Y 1Acvft NOfC to <br /> SYSTEMp ELEVATION t 7 gore • 601 /DO kAiL /tUeASfOf D"—bid PidE <br /> • AL <br /> SD' <br /> y <br /> % 5 = <br /> n. <br /> TN <br /> 'D Rlk <br /> L-� (✓'vE <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and metl ods 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 (p int): TESTS WERE COMPLETED N: <br /> n U <br /> A DRESS CERTIFICATION UMBER: PHONE NUMBER(optlona0: <br /> C GN URE: <br /> 'I <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> IILHR-SBD.6395 (R. 10/83) -.OVER - <br />