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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> 3707 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION:j SECTION: ����//�1 p /Irf OWNSHIP/MUNICIPALITY: � 11 LO.�.T-,NCCO.:BLK.NO,: SUBDIVISION NAME: <br /> Env 1/4 ,/ l 1TjC N/ROE for IC!IV vf4� <br /> COUNTY: OWN^R,5 BUYER'S NAME: MAILING ADDRESS: <br /> 0aw�'1 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRM3.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> 'Residence � u (y_ ew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOOU�UNppN <br /> D: I_ -G�ROUNpD-PRESSURE: SYSTEM-IN-FILL HOLDIpNG T�jAN K: RECOMMENDED SYSTEM:(optional) <br /> �_❑U L zr3 0 I'M 0 19-Si ❑$ �U Loauc�rTiorR-L- <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> 4 If any portion of the tested area is in the A10under s. ILHR 83.09(5)(61,indicate: — Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, OBSERVED EST. HIGHEST— TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B l ?6" 9y,p' �o�E �6 9r5� 1i /6 '/�F5• 22` �rr3 . s"gvLS.�' s S <br /> B- 46 9�l'6" No�C 7 ��' 9" SL-T5 to" RFs 5o" otjF5 io"RFs YL" gt-1_ <br /> B- 3 fid'' 93,9 r� ��' rs it W-s 2?" (3r�� 15'k9F5 3o OvL <br /> B- N 8G yY=o" t� g-(o` 4' I�,L Tic, <br /> 13- 5 Yb ''-6" onL � , 11 ly FS a ` 6r FS 14 RFS -` &pe�- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHESRATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOOI PERIOD2 P RIOD 3 PERINCH <br /> P " N06C <br /> P- 33" 3 �l I t <br /> P- a 3 t u <br /> P- <br /> P- <br /> P- <br /> PLOT PLAN: Shaw 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 4/ qff Rio <br /> s <br /> y <br /> A <br /> • �� • r�pP,'� <br /> N <br /> AT PG OF CHI fnAq <br /> pro loco SIodo <br /> RODr <br /> I,the undersigned, hereby ertify that the soil tests reported on this form were made by me in accord with the procedures and methods pacified 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): 4L 0 /� TESTS WERE COMPLETED ON9-7 <br /> .:i7 <br /> 11i C. A - ' �D O / <br /> ADDHESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 3 g 1!' u i V � - Ivy 3 <br /> CS SI URE: i <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-8395 (R. 10/83) -OVER - <br />