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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> DIVISION <br /> INDUSTRY, <br /> P.O. BOX 7969 <br /> LABOR AND PERCOLATION TESTS (115) <br /> HUMAN RELATIONS �� <br /> �' ((�� MADISON,WI 53707 <br /> (1 LHR 83.09(1) & Chapter 145) J /—p�— <br /> LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> sE'/•SA A/4 10,5 M MEEAAW <br /> COUNTY: OWNER'S Ri NAME: MAILING ADDRESS: — 7 ­Y,06 3 <br /> ,BON F-rT WARD oDE c s aS L L Cas / <br /> USE DATES OBSE R V AT ONS MADE <br /> NO.�MS.: COMMERCIAL DESCRIPTION: M1y PPOFILE E RIPTIONS: ERCO A ION TESTS: <br /> Residence /�I//ffyt I-�New ❑Replace �3 S!7 '7 <br /> RATING:S=Site suitable for system U=Site unsuitable for system /\ / / <br /> CONV E NTI O❑NU . MMS.❑U IN-GXS EJ URE: SVSoTEM-I N-FILL HO L❑DINGi K: Rn00/MvM�NDED SYSTEM: ptionall7s/ <br /> S rj`N DESISGN RAUpp�/ S U S U C. ..J <br /> If Percolation Tests are NOT required �7 /� If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: /v,L-Ih Floodplain, indicate Floodplain el evanon: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH 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- 6 9 .G7 A W/6 '�&5'/ ' s <br /> B dNf_ %D '4/5/ S " S'B d . <br /> B- 7-)L- 93.9 / 6A/6 �2 /d -6" hs Zf„ MoT Fs <br /> B- 4lv ?,9a/ dNF_ 7/41S/ 5a'�617S 6Ao I &14W /P Mi <br /> B- .3 P.2' oA- 7'Bls/ - s w e <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. PERIOP 1 PER124,2 PER D3 PE INCH <br /> P- �n�^ / <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 surf- -tion at all borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION %2,17 LAO R <br /> SCALE I-,6L6C& = /6 <br /> •W�Lf— <br /> °� SM - N411- /4l jV111tE 041 <br /> EL - lad <br /> 04 �( <br /> p Soft- BAVA/G s (1,10A/OE) q PRoras y� V t N <br /> �4ousE <br /> .A FIERe 7_r5S <br /> tpo� <br /> A.�py'r( <br /> /Toot <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 theNfVisconsin <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 90MYLETED ON: <br /> 1�E11) SrRaBF L 7 <br /> ADDRESS: CERTIFI T NUMBER: PHONE NUMBER(optional): <br /> R7: -a -,I- i <br /> CST SIG URE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />