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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & B DIVISION INDUSTRY, - PERCOLATION TESTS 115 BOi7D9 <br /> LABOR AND , r P.O. BOX 7969 <br /> HUMAN R/ELATIONS \ / MADISON,WI 53707 <br /> ( OOv, 21 (I LHR 83.09(1) & Chapter 145) <br /> LOCA' N: ,'V SECSI.O%T36A/RI� (or T a FII [Me, /� rLITY� LOT NO.:BLK.NO.: SUBDI VISIONrk"o/.-1 'n /3a <br /> JT /T- ,�Cf� 3 C/..'J T <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDR TSS: <br /> k111 e- Ilia—;,, S, QY ah T G y.f f�. J- j-tr.. /{o t , t�!, .✓..y'C>� <br /> USE DATES OBSERVATIONS MADE <br /> F��17 NO.BEDR COMMER AL DESCRIPTION: P N A I TESTS: <br /> .�yResidence ONew ❑Replace <br /> f��/. J s.�s Ali< ,5 ✓9�,s <br /> RATING: S=Site suitable for system U-Site unsuitable for system <br /> CONVENTI NAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FI LL HOLDING TANK: RECOMMENDED SYSTEM:(gptional) <br /> �S ❑U S ❑U S ❑U ❑S 2U ❑SRV Coh ch Tian <br /> If Percolation Tests are.NOT required DESIGN RATE: If any portion of the tested area is in the /q�/ /!L^/ <br /> under s. ILHR 83.0915)(b),indicate: Floodplain, indicate Floodplain elevation: / Y // J <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL PTH TO GR UN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> ( n <br /> B- 5701 Zo3/�/ /vOhC. `✓ S � —(a <Li 1. b — �� �/i i, 5'� — .S �h G <br /> B_ 7 /�" �O3 j /G o— <br /> B- 3 5G" /a.2 : �o % SC p - / s • - s'a::',, lh„'' >- f� o <br /> B <br /> /- a i3r ) <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. P I D1 PERI D2 q . PER INCH <br /> P- IX h — 7 <br /> P- 3 413 a - _ Z 3 <br /> P 3 <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 ELEVA 110N /'o 1;4 <br /> /b <br /> Op h,l o -e rb <br /> - <br /> p <br /> 1 <br /> —rte__I T N <br /> 7 <br /> I � !•! �,y y I I j <br /> e. <br /> I --� Oki I <br /> �- <br /> C _ r ' <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 /> �� G L7 C'11 G/l k 1. Sr %<('J- <br /> ADDRES <br /> CERTI FI TIO NUMBER: PHONE NUMBER(optionall: <br /> ok fr .,2 Y <br /> CST SIGNATURE: <br /> J) ; <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DI LHR-SBD-6395(R `10/83) —OVER — / <br />