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NSAFETY & BUILDINGS <br /> INDUSTRY, <br /> DEPARTMENT REPORT ON SOIL BORINGS AND <br /> LABOR NDUSCC <br /> Iy <br /> AND <br /> LATIONS PERCOLATION TESTS (1155, P.O. DIVISION <br /> HUMAN REBOX 7969 <br /> (I LHR 83.09(1) & Chapter 145) 30' ZFj MADISON,WI 53707 <br /> LOCATION: <br /> SECTI N- TOWN I /MUNICIPALITY: LOT NO.:BILK NO.: SUBDIVISION NAME: <br /> % /T� N/R / E(or <br /> Y: OWNER'S BUYER'S NAME: } MAILI ADDR SS: <br /> USE ' v <br /> NO.BEDRMS.: COMMER IA DE R PTION: DATES OB RVATIONS MADE <br /> %Residence 7 1 <br /> /V� � N p ON "ESTS: <br /> New ❑Replace I GY _3.� 19A� l'� <br /> RATING:S=Site suitable for system U—Site unsuitable for system �U- <br /> CONVENTIONAL: <br /> MOUND: IN-GRO ND-PRESSURE: SYSTEM-IN-FILL HOLDING T NK:RECOMMENDED SYSTEM:loptional) <br /> ®S ❑U Ns ❑U S UU Ss U ' <br /> a r <br /> [�If�Pe�rcolationests are NO�required�DES;IGN <br /> 3.09(5)(b) IIf any portion of the tested area is in the <br /> Floodplain, indicate Floodplain elevation: I/,4 <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL OUNDWATER-INCHES CHARACTER _OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION70nBSERVED ES HE TO BEDROCK IF OBSERVED (SEE ABBE ON BACK,) <br /> B- I S qr,��i <br /> ry� "q <br /> V. . <br /> B- ' /L <br /> v _ V <br /> B- o Y'�, 70 iv0/V 4 7 U� f3� 8(v� 7'Sj `BN,SLS— G D&V�j <br /> B- ✓ 9z) qI. l %V'aN 7q6i3 '6'x'1S��7s frf 6iv,5�- �''Y, Biv5 <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEH ER INNUMBER NCH S AFTER SWELOLING LE INTES AL-MIN. DROP IN WATER LEVEL-INCHES <br /> PERI D PERI P R RAPER INCH TE ES <br /> P - l J j C I . <br /> P- 3 <br /> P- T f <br /> P_ <br /> LP- <br /> PLOTPLAN: 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 <br /> of land slope. RSO / 8.4 borings and the direction and percent <br /> SYSTEM ELEVATION 89,E 68.ij'� <br /> fi <br /> -_ 6'�cli <br /> IN <br /> I ( I f <br /> I <br /> I <br /> i ( j ._ 1 —+ <br /> _�'— ' [ <br /> F— � I L <br /> wNl�w iR ' ) <br /> .. 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 print <br /> T�EjS. 1:S MlEI I CO <br /> r5'_ <br /> ON: <br /> ADDRES� / a -�Y X98-7 <br /> CERTIFICATION NUMBER: HO <br /> PNE NUMBER(optional): <br /> �C r/ 4 6 �f'' G iso ,�7 3�7 - 4-21 <br /> CST SIGNATURE: <br /> / � n <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. LJ <br /> DILHR-SBD-6395 (R. 10/83) <br /> —OVER — <br />