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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR ANDPERCOLATION TESTS (115) MADISON,P.O. BOX 7969 <br /> HUMAN RELATIONS r SDN,W153707 <br /> 3707 <br /> (ILHR 83.09(1) & Chapter 145) 00V t- LO—) s <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDI VISION NAME: <br /> �/'/4,SWY 27 /TgDN/RltoEto W O K� a C'SlInV. G <br /> COUNTY: MAILING ADDRESS: <br /> URtJF-Tr GENE-_ P _FSC N 2�(PIS E111NG�_K RV <br /> USE DATES OBSERVATIONS MADE <br /> I�y <br /> NO.BEDRMS.: COMM R IAL DESCRIPTION: A ESTS: <br /> MF!esidence ❑New Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system ( J I I J <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDIN TANK:RECOMMENDED SYSTEM:(optional) <br /> ®S ❑U $ ❑U �S ❑U ❑$ U ❑$ U Cot4M E T1)S <br /> It Percolation Tests are NO7 re wired DESIGN RATE: <br /> 9 If any portion ofthe tested area is in the <br /> Pricier s. ILHR 83.091511b1,indicate: r— - Floodplain, indicate Floodplain elevation: N <br /> /q <br /> r <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALP H T GROU DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED I EffT7UffHTST­ TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 dao 100 . 1E >�60 0-&B) k &-2�a,F zy -Ioo3jjfF <br /> B- 2— 99.9 IVONC > o IIs -2o5js 2o- 9(, BNm5w r <br /> B-3 `)& �p o rC >Sq 0-Oaks 6- 231�41I5 -73 - B4'�NMSw r <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> YTEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> i NUMBER INCHES- AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI D2 PERIOD PER INCH <br /> P- 1 Z tJo / 3/ <br /> P-Z '2 3/ y <br /> P 1.To 3/ ' i -5– <br /> P_ <br /> p- <br /> P_ <br /> PLOTP- <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate stale 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 /> r..__ <br /> .. _ _ r_ .. <br /> , <br /> .�►Bh�l IOo �R�latJ Z`� DJC _ _ � . <br /> Jon- 76 toe-64�oe <br /> PRIVc <br /> ;, 2D0 <br /> am <br /> 3�D 3 s G <br /> P1- r- <br /> PY515r/NG $fo <br /> Lo <br /> Iq 77 <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 speciflin th sconsm <br /> Administrative Code,and that the data recorded and the location of thg.tests are correct to the best of my knowledge and belief. <br /> NAME (print) <br /> WERE COMPLETED ON: <br /> CN <br /> ADDRESS: RTIFICATION NUMBER: PNE <br /> HOUMBERIo banal): <br /> lJc"S3 r�fZ WI . si{8013 It r JUL t 36 o -760 . 1 <br /> S, lS NATURE <br /> "TRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> .HR-SBD-6395 (R. 10/83) —OVER — <br />