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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> -INDUSTRY, DIVISION <br /> LABOR RE PERCOLATION TESTS (115) ' MADISON WIX53707 <br /> HUMAN RELATIONS <br /> (I LHR 83.09(7) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.N .: SUBDIVISION NAM E: <br /> IJE '4S '/ /T3q N/R ISE (p )W EEnI n/ <br /> COUNTY: MAILING ADDRESS: <br /> RAM USS 0 U N Zi CtfF_t_.Mo EB r. 8 <br /> USE DATES OBSE VATI S MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: R PERCOLATION TESTS: <br /> Residence ��_ New Replace / - IO - / 'O- O r 1 <br /> RATING:S=Site suitable for system U=Site unsuitable for system b 'V l�( <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-I N-FI LL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ns ❑U Ns ❑u ®s ❑U S ❑U I ❑S ®u <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> q If any portion of the tested area is in the <br /> under s. I L H R 83.09(5)(6),indicate: (- Floodplain, indicate Floodplain ele at ion: I'r <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL PTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. HET TO BEDROCK IF OBSERVED (SEE ABB V.ON BACK.) <br /> O - lad (a- wo Spl <br /> B- I �� 9(11 14046 -;' (4 <br /> 8-2- '72 91A Nli > '72 O-b$I -? H <br /> B-3 Z q1 .2 Nart6 <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODI PERIOD 2 PE RIOD 3 PER INCH <br /> P- 1 19 140 S t�'r� s 3 <br /> P- 2 1 0 it. i / Lf <br /> P- NO <br /> P- <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate sca a or distances. Describe what are the hori- <br /> zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation a all borinag and he direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION <br /> _1 <br /> I I , <br /> pP7tox - <br /> I ii <br /> CK1L� ('r 4o u Nbr TN <br /> AXM 100 ,$DITbii .l Si <br /> FIRS # Z(,931 v <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedu as 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. r <br /> NAME (print): TESTS WERE COMPLETED ON: <br /> RrcNAR� f�D9KrrJS b- 1+7 - '1 <br /> ADDRESS: CERTIFICATION UMBER: I PHONE NUMBER Ioptional): <br /> 2� lbo %%85-re2 WI . 54893 300 1%-U- q 15 <br /> CST SIGNATURE <br /> (c -17-4Y <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DI LHR-SBD-6395 (R. 10/83) -OVER - <br />