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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND. PERCOLATION TESTS (115) MADISON W 53707 <br /> HUMAN RELATIONS <br /> ov, (o (ILHR 83.0911) & Chapter'145) ' <br /> ILOCATION: E TON: TOWNSHIP/MUNICIPALITY: OT NO.:BLK. )ASUBDIVISION NAME: <br /> '/ '/ /T N/R Ilo E (o W Wti✓ ART C'sm V R :�. Z <br /> COUNTY: MAIL <br /> E ZVI M C A SE 3 L SSD <br /> USE DATES OBSE IVATIONS MAD <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: . <br /> ❑Residence 7 �� ❑New I (Replace j l� 3 <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> Rf��T❑� • M_.fl�.❑� I S ❑U . SY S •�UL F TA K: CO MENDED YSTEM:(optional),. <br /> If Percolation Tests area KNOT required DESIGN RATE: If any portion of the tested area is i the <br /> under s. ILHR 83.0915)(b),indicate: [�--- Floodplain,indicate Floodplain elevation: N <br /> PROFILE DESCRIPTIONS - <br /> BORING TOTALP H TO GROUPDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION <br /> OBSERVED E9T.HIE TO BEDROCK IF OBSERVED (SEE ABB qV.ON BACK.) <br /> B- i I q oni� >18 0- & Ifns -18 Nms <br /> B-2— oNE (k O-`l Blms `1 -4Io M <br /> B-3 8 118 .o E � '] a-�Blm� �- 88►Jms <br /> B- <br /> B- „ <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I _PgftIPERINCH <br /> P. o b s 3 <br /> P. 2 tj n 6 Li <br /> P- / ' f c <br /> P- <br /> P <br /> P_ <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scat s 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 borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION X14- 9 <br /> _ n - <br /> Ry <br /> - - - - --- - --- <br /> -[i IN KE <br /> hi►_.- - <br /> 13 <br /> 77'- <br /> - - <br /> - - - — : <br /> 1,the undersigned, hereby certify that the soil tests reported on this form were ade by me accord with the procedunes and met ods s cifi�e✓d• in a Wi consin <br /> Administrative Code,and that the data recorded and the location of the testa are correct to t a bes of my k o edge and lief- s/ • �(J s� <br /> 449 <br /> NAME(print : ERE COMPLETED ON: — II•• <br /> /c S - 11 - 3 <br /> ADDRESS: CERTIFICATION UMBER: I PHONE NUMBER optional <br /> n 35- W99ST1 . M 3(o70 <br /> CST SIGNATURE: <br /> Ll4vJ <br /> DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHRSBD-6395 (R. 10/83) —OVER— <br />