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INDUSTRY, <br /> NDUST OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRYY,, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (H63.090) & Chapter 145.045) <br /> LOCATI�:N 1 SECTION: TOWNSHIP LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> SE /aw/a / /T3gN/R/7Fr+�)W L/lVCOLN / I N,t /VA <br /> COUNTY: OWNER'S AE: MAILING ADDRESS: <br /> 941W/ TEF ELM L. OeW 3 2gg2 X10F 57,, sT Pi9t/L M/Nil/, S5//3 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DES RIPTIONS: PERC LATI N TESTS: <br /> Residence � Ne El Replace ILIA <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: YSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ®S ❑U �J S ❑U RI S ❑UISMS ❑U ❑S ®U �t/tr NTiyN L <br /> E DESIGN RAT : <br /> If Percolation Tests are NOT required DES If any portion of the tested area is in the �� <br /> under s.H63.09(5)(b),indicate- /1A 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 EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- / "1:2 99 A10/v, > f2 sign s� "gn Int5ws <br /> B-Z 6,"- q8"3" >62 _r/!I9A .15/ 58`( on mF S <br /> B- 3 60 %'9 > 60 " 41"Ag4 S Z 5el, " '7 m -,os <br /> B- y �S ' // r/",?,y sL 60 'g;of n7'-ds <br /> t " 07 T65i F F <br /> SL 70 9,1 ` T <br /> B o 70 SL " <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERT D 2 PERIOD 3 PER INCH <br /> p_ / OIV� L <br /> P- <br /> P_ 2 <br /> P__ // 2 2 3 <br /> P- Z 2 < 3 <br /> 9 Y 41 2 2- <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;heir location on the plot plan.Show� � <br /> the surface elevation at all borings and the direction and percent <br /> of land slope. /�/ 4 ��Qu�R�d Sy7/G/�r Z, /ev 6 1,�r/ <br /> SYSTEM ELEVATION RD. <br /> f T _ <br /> +� uiB5� <br /> �A �' s - d P6 s <br /> fA <br /> P <br /> - - - <br /> Tor <br /> a ' OA53 <br /> 01 <br /> tN <br /> az i <br /> 0 o i <br /> j <br /> T, N <br /> I E <br /> j <br /> OTA/NE <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(print): TESTS WERE COMPL TED ON: <br /> C LV IN 13ENso Al /3 8 <br /> ADDRESS- CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> f 2 lttlF�STE l5. 5 158,( 7i5- <br /> CST SIG A <br /> 47f- <br /> -RIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> 3D-6395 (R.02/82) —OVER — <br />