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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 /> ((LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MNte"A'ErTY: LOT NO.:BLK.NO.: SUBDI IS(ON NAME: <br /> ,5w '/ uE�/ 2 /Ty/N/R/6I(orlW t1 <br /> c-airs <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING MAILII�NG ADDRESS: <br /> )dJ strrlr I-�l7— pot-TA eet t itllTrfq1Lklt- <br /> USE DATES OBSERVATIONS MADE <br /> NO.SEDRMS.: COMMER IALDESCRIPTION: PROFILE DIPTI NS: PERCOLATION TESTS: <br /> Residence 2- 1 <br /> XNew ❑Replace fD� O � A /0 „P_97 <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE -IN-FILLHOLDING TANK: R ECOMM ENDED SYSTEM (optional) <br /> rVI S ❑u ®$ ❑u $ ❑u ❑$ ®u ❑S ®u C. olivo <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)(6),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, CO OR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> e- I � � 9�rS ow-� s`_ lgtr &'�r S l�" �� y�,IP r <br /> B �-- $� Q�r 6 /E"e�, fw.�s 8'C " ryn Fr�s <br /> B- - q7 d-- 9 D. 1\ •7 a-- 01'� / rr <br /> B- l 0 `1 0 16-4"Btlr 6" .,�v S / r, Y if <br /> e7 a 61 '1 " > Re 0-s"'das r <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PE RIOD2 PERIOD PERINCH <br /> P- 1 '3 S/ 2 <br /> P-0.1- /376T <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 disti nces. 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. � �j A NCf L X� "TP e M 00 Q <br /> SYSTEM ELEVATION / gy,Q P- <br /> sc,ac � i'r; y1,• �, car Nord ��,� +� <br /> o <br /> ra- <br /> tE--- 87 0 <br /> rK r r <br /> 3 �p <br /> 1,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and n ethods 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' t): ITESTS WERE COMPLETE ON: <br /> r It <br /> AD RESS: CERTIFICATIO NUMBE PHONE NUMBER(optionaI0: <br /> � ► 6 1' �,, ' �� 3 ?rs-�t�E-yrs <br /> CST S N TURE: ^ <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. f <br /> 1-HR-SBD-6395 (R. 10/83) —OVER — <br />