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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, - DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (I LHR 83.09(1) & Chapter 145) <br /> Mel/SE '/ SECTIOjTV N/R/Si (or)W TOWN SHIP/0ltifs'_c TPV: LOT NO. BL,`� SUBJJ4p/.r NAME' - J <br /> C UNTY: OW,ry.cg 5 BUYER' ME: / MAILING ADDRESS: J7J /✓ GJU X-570 <br /> 4 r`h 6 /i'o - To r, d 4 n.. N c s-7' .ST Po. 6 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: I� PROFILE DES RIPTIONS: PERCOLATION TESTS: <br /> Residence rp New [-]Rep 17 7_� <br /> RATING:S=Site suitable for system U=Site unsuitable for system / 0 -3 <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ®S ❑U INS ❑U I CBS ❑U I ❑S OU I ❑S ©U I ii6ev ''I <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED I EST. HIGHEST_ TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- ( `B4> 10a ,) 11111"e > f 4 e/iii &M Jr �S' Y S 'S'/ " R G <br /> B- $p S- 1 t f? � it C <br /> B-'S- 10 ' t, ��� . �J11 RM, ds It /? C S- <br /> B- <br /> PERCOLATION <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. PE IOD1 PERIOD PERI D PERINCH <br /> P- 3 0 9 <br /> P- a- 3 3 to <br /> P- <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 97, ll <br /> -f— / s <br /> ..�,xcerrf �r k,e•< /lla 'cd S �esr,� <br /> � D <br /> 0 f ` <br /> s�Pt Will <br /> Ap.dxt v <br /> 4CLA-14 -e CV r E S� Sra • a 3 <br /> 84I, 1 <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(pr nt): r TESTS WERE COMPLETED ON: <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optionaT <br /> w- sc . S dy 3 1 70T-fi' /J' <br /> C7_NAT RE: " <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. Y <br /> 40, or <br /> DILHR-SBD-6395 (R. 10/83) -OVER - <br />