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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY _. DIVISION <br /> 969 <br /> LABOR AND - P.O. BOX <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 537073707 <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> Gc/1/5tv�/ /T N/R61In e�saN <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: 3(>Q <br /> 1,eve 0471? <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER OLATION TESTS: <br /> Residence /� A -]New Replace I /Q�0/4' Sr <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SVST EMaoptional) <br /> ®S ❑U ISS ❑U �S ❑U M ❑U ❑S PSU w.LurrT�o.�ge <br /> DESIGN RATE: <br /> If Percolation Tests are NOT required //�� If any portion of the tested area is in the <br /> /-T <br /> under s. ILHR 83 09(5)(b),indicate: A, — Floodplain, indicate Floodplain elevation: A.)Q/l.lj!�-: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH TO GROUNDWATER-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.1 <br /> B- <br /> B- 6y" C/� % fr 76 6 �� 5� Ck*i 51- 15r "1105 <br /> If <br /> e- ill " /00-0 ' kt( rar BC. 54 IS 39- (PpA'.Utd__ BI- 1Mbos. <br /> B- y Yy" /a0`-0" $ (o' L 57Gr2twest. �" 8N u15n 5. <br /> B- 5' b q�' 67' c-" 51" 6f.Aw=1_ 4,2• N <br /> B- <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 1 PERIOD PERIOD3 PER INCH <br /> to <br /> P A 4 l9 g <br /> P- 6• 1 i <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 /> I <br /> THIS CoK&LWZ !S <br /> F-JZ6.p coo <br /> �` <br /> �alsrc �N <br /> 30 �y \1340.Tap 0i— <br /> 5-96 <br /> 12S-0` 69w1 49k4ff- <br /> I,the undersigned, hereby certify that the soil tests reportedon I is form were made by me in accord with the procedures and methods specified in the Wi consin <br /> Administrative Code,and that the data recorded and the location o the tests are correct to the best of my knowledge and belief. <br /> NAME (print): TESTS WERE COMPLETED ON: <br /> ! 0 A,4 Rory, lo[to t►- <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> RT rho x 470 L4 W(', !Nt)o -2cr acly 35t <br /> CST N TU <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. �. <br /> DILHR-SBD-6395 (R. 10/83) -OVER - <br />