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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 533707707 <br /> (1 LHR 83.09(1) & Chapter 145) <br /> 0 AT N: SE TION: � TOWNSHIP/MtiHleflRtf;y: LOT NO.:BLK.NO.: SUBDIVISIONNAME: <br /> E Y4 NE �� _f o /Tx1dN/R/L-E for <br /> COUNTY: WNER S 8 YER'S NAME: AXOPAA) MAILING ADDRESS: 090- W? ELIOQ <br /> URNE1`T LO/UA /E AuRER's `�9/ lvt S <br /> USE DATES OBSERVATIONS MAD <br /> NO.BEDR ICOMMERCIAL DESCRIPTION: r,� TS: <br /> Residence J / ❑New �lReplace <br /> 44 <br /> RATING:S-Site suitable for <br /> rrJsystem U=Site unsuitable for system •y O `.l <br /> DMSToUIONALM®J �U INGES ElU ROUND-PRESSLIRE: S SOTEM-I.t'S1ULHOLDING DS yu <br /> required R�nMd,NDED BED ST�o7 t's�� <br /> If Percolation Tests are NOT re DESIGN RATE: S <br /> 9 I If any portiin on of the tested area is in the ^ <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplaelevation: A <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED ES HES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- V�Jv/ ` /v � >,Y� lo s 71/,re . <br /> B- D > sf <br /> B " / S/ 7.2 " ; .. <br /> B- <br /> B- <br /> 13- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. —pEglopl P I D PERINCH <br /> P- 3 F < <br /> P- sr / b <br /> P" F n <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 /> Ma,s4J14 LA&E <br /> »5, <br /> SC/J�c <br /> SF &*NC <br /> Ncu56 <br /> m ffcrv� ,13i'1 — BorroM of srlvnlG <br /> �s w - - �nn i R OF NeOSE <br /> y�l' nr< -91%arjaAT1 C-.14i <br /> a sac ,&f a/.t/Gs t N <br /> .� >�'ERc rESTs <br /> 0211 <br /> Q f/RL•# O 797A <br /> �AkE Ro�A <br /> rfiAYpCAI <br /> I,the undersigned, hereby certify that the soil teats 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 /> AM print : TESTS WER AOM LETED ON: <br /> ADDRESS: CERTIFIrCATION NUMBER: IPHONE NUMBERIoptional): <br /> a- 3 - O <br /> CST SIGN TORE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHr 35 (R. 10/83) –OVER – <br />