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DEPARTMENT-OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, r __.... DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/ V: LOT NO.:BLK.NO.: SUBDIVIS ON NAME: <br /> 21 /T 8 N/R, �)W Daniels na na na <br /> NW1� NW 1/4COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> BurnettEugene Becker 1615 S rin HastingsMN 55033 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIALDESCRIPTION - PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> Residence 2 na New Replace6/10/87 na <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM (optional) <br /> ❑s OU ❑S DU ❑S ❑X U ❑S DU ©S ❑U olding tank <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. I L H R 83.0915)(b),indicate: na Floodplain,indicate Floodplain elevation: na <br /> PROFILE DESCRIPTIONS <br /> BORINGS TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPlHIN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 22" 97.60 none 22" 1411 Gy sil, 811 Bn c w/mot R cmd @ 2211 <br /> B- 2 24" 100.55 none 2411 911 Gy sil , 1111 It Bn f s w/mot R fff, 411 En c wm and <br /> B- 3 15" 97.50 none 1511 811 Gy sil, 411 It Bn f s , 3" Bn c w/mot R cmd. <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. PERIOD PERIOD2 PERIOD PER INCH <br /> P- <br /> P _ <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 lna <br /> hole <br /> / 9- 6M Top ofnll�L <br /> 61 s <br /> f� In <br /> BI 63 q�A e4fP100,00 <br /> SI�S�'+ <br /> 51' T N <br /> g: MIy Wei: dold;rw Tank- mof bu <br /> mfn ?S` (rorn <br /> r�Hw�5aI�9 <br /> Pe cr rr Zoo' <br /> 0 <br /> H114 70 <br /> I, the undersigned, hereby certify roar 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 (p,uo) ITESTS WERE COMPLETED ON: <br /> Joan E. Daniels 6/10/87 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> ROX W Siren, WT 54872 _ 4 11715-349-5364 <br /> S I,G NAT/URE <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soll Tester. y <br /> DILHRSBD$395 (R_ 10/83) —OVER— <br />