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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY.-, DIVISION <br /> 69 <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53BOX 707 <br /> HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> U)1/4 �y /TypN/R16E (pr ori q 29 <br /> COUNTY: MAILING ADDRESS: <br /> 13 _'0 0 z <br /> USE AV, <br /> OBSERVA IONS MADE <br /> NO.BEDRMS.: COMM R IAL DES RIPTION: PROFILE DESCH <br /> A TS: <br /> .®Residence 2- 1- New ❑Replace 19 �1- - is <br /> RATING:S=Site suitable for system U=Site unsuitable for system _I 1 0 _1 D <br /> CONVENTIONAL: MOUND: IN-GR OU NDFRESSL111 1SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:toptional) <br /> ®S El I ®S ❑UI ®S ❑U I ❑S ®U I ❑S ®U Co1vAl <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.091511b),indicate: (L_ Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL A <br /> P H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, NO DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 $0 19.0 NDN8 '7W 0- 581 tts 5- `d0 Boll <br /> B- 2 4/ () <br /> 0 ll ANE > 130 0 Bi M5 � ' `�O13gNms <br /> X <br /> Ella !Z- $' do ll 7172- Q-L S1 MS (V - 7Z GN MS <br /> B- Lf 72- 11 ],°l NONE > '77_ 0 -515M5 6- 72- l <br /> B- 5 72 q . 7 IJaNE > ?2 9AN E 18-3 <br /> B- <br /> PERCOLATION TESTS <br /> ON <br /> C -TEST I DEPTH WATER IN HOLE TEST TIME D I WATERLEVEL-INCHRApERINCH MINUTES <br /> F NUMBER INCHES- AFTERSWELLING INTERVAL-MIN. p l D1 P RI D <br /> P- 1 PO yl L3 3 <br /> p- 2. 3 11 <br /> p- 3 30 go 17 Y12 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 9-5r.9 <br /> _ tar 4 u6 <br /> . _ Y <br /> �IU�IZ IZ?o $LDG a0 e0 <br /> z7 <br /> e3 p <br /> SCALE )''- 40' 1 4s N <br /> •8n 100 NF10. 11J iW,u ID"AfA OAK <br /> n QRc <br /> • .�,oRE �R1vE <br /> LOT 1,114 <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> NAME print TESTS WERE COMPLETED ON: <br /> (CHARD {fo�KluS - - <br /> ADDRESS. CERTIFICATION NUMBER: PHONE N LIMBERIoptionall: <br /> Wt,85r69 wI 5y$g3 367o K-S�6 - Is <br /> CST GNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHRSB"395(R. 10/83) -OVER - <br />