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TMENTOF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUS <br /> INDUSTRY; - - DIVISION <br /> LABOR AND P.O. BOX 76 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> R <br /> 0LHR 83.0911) & Chapter 145) <br /> LOCATION:s� SECTION: TOWNSHIP�/M Y: LOT7CT O :%U .: SUBDIVISION NAME: <br /> NW �/ Y �c /MN/RJV1 (or)W s- y <br /> r/A <br /> COUNTY: OWNER'S/BUYER'S NAM MAI LING ADDRESS: <br /> Bvrha I�L( eh ST /� vsi 6 S �v7 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: ccam�,, PROFI DEC PTIONS: ER OLATIONTESTS: <br /> Residence YSINew ❑Replace (� O <br /> RATING: S=Site suitable for system U=Site unsuitable for system d G a <br /> CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FI LL HOLDING TANK: RECOMMENDED S 'STEM:(optional) <br /> S ❑A ❑S � GWS ❑S ❑U EISA U Cow . <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> q If any portion of the tested area is in he <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain eleva ion: <br /> tea,`I 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. IGrHiEST TO BEDROCK IF OBSERVED (SEE ABBR .ON BACK.) <br /> B" / 4 �/ • � p�ON`Q 7 7d q"49&4s t/- <br /> 1o'/y[r /0"/P 07(! WIA. MC . <br /> 111ko-& " BCcr a'••,."e tr io" f!" ITC Ljlpn O Rr_ w .D <br /> RLS 4tip / " e S <br /> B- T CiIfek 7p 0 4YfIfV 80 c <br /> 13-�l 77 sff h% *I -.W 3 <br /> B- w.,1c <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD PERIOD PERINCH <br /> P- 1 3 6 Aa o rs 7/4f 3r <br /> P- <br /> P- /0 <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 r 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 II borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION 9s <br /> 1PrG • <br /> Sca4•e y0 ore Ar <br /> /Mood 7- <br /> Y sem; <br /> T. e <br /> ba , 4r-Pq <br /> r� TN <br /> N.I zu 3o w�1< pIN< —'�O , <br /> , 1 <br /> iq r <br /> P�pP�r7z /^T tet Y�r 17• <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedure 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 b lief. <br /> NAME (print): TESTS WERE COMPLETED ON: <br /> PO � r`tck o as <br /> ADDRESS: CERTI,FJCA ON N MEER: PHONE NUMBER(optional): <br /> w-e6aT� r Lk f S'�18I3 Y7 1 Ips-f(ob,4/e4 <br /> CS IGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. ' <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />