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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 /> (ILHR 83.0911) & Chapter 145) <br /> FL—OC ATI N: SECTION: TOWNSHIP/0161"em"l YTT: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> o✓ 14 '/ 5 /Ty N/R l6T-ttQ W son/ 2 OJA ►�,� <br /> COUNTY: vjkR SNAME: MAILING ADDRESS: <br /> M T s o <br /> USE - DATES OBSERVATIONS MADE <br /> NO.BED COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER OLATION TESTS: <br /> ®Residence 3 riA ) New ❑Replace I g_�b - 575 S -i6- 85 <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOOU�UttND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ®S ❑U 1C�S ❑U ®$ ❑� ❑S ®U ❑S ®U Gav <br /> DESIGN RATE: <br /> If Percolation Tests are NOT required //�� If any portion of the tested area is in the �1 <br /> under s. ILHR 83.09(5)(b),indicate: f4A Floodplain, indicate Floodplain elevation: 14/► <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTHIN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- , Sbk10 tim OHIQ VOB15, 22.1 T .. ` <br /> B- ?. 72 m/L 0 r' 11 1 7,V 'Y* ) y 5 1.7"A.�s a +/,7w J(' <br /> B- 72 "TV/0" 11 11 11"131 <br /> " / T I o " <br /> A /) <br /> B- 7G /*I is 1� > 76y"Al r d" ! <br /> 13- <br /> '72 l6 = 1 1 A 57 <br /> 72 w'-24 I'-2 ,1 7A 06 51, 3 S <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PERIOD 3 PERINCH <br /> P y0 7 <br /> P- 32 IJo 3 3 3 <br /> P. 9 tr lidp z 3 <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 <br /> _ p/NE ��4lrt� ❑: bQRE Tts <br /> �� S1sPE o _ pfoc TEsr <br /> `il e Ak a 6 M. VA gra na PF <br /> ? Assu,nfo Flo✓ /oo'-oel <br /> �Ne P3b6 � <br /> n v. <br /> e° %4 ,s' N <br /> B <br /> Iowa To 7J�i�eM�py <br /> 0 <br /> v <br /> !1 <br /> I?6 -► ALT I$'x3f' Aor <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): ITESTS WERE COMPLETED ON: <br /> EOwi9R0 W c�s►R — i — �S <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> / S)A&Al Ahr SVS Cif' U 9'2 <br /> CST SIGNATURE: <br /> F <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. —� <br /> DI LHR-SBD-6395 (R. 10/83) —OVER — <br />