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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR'A'ND. PERCOLATION TESTS (115) MADISON INI53707 <br /> HUMAN`RELATIONS <br /> ((LHR 83.0911) &Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: <br /> SWY E '/+ 12 /T oN/R pE UN 5 R <br /> COUNTY: MAILING ADDRESS: <br /> F>URN6rj1 SACK 6' <br /> USE DATES OBSERVATIONS E <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: IPR DESCRIPTIONS: PERCOLATION TESTS: <br /> [Residence 2 ���_ New ❑Replace f /1•� . �? //-S- <br /> RATING:S=Site suitable for system U=Site unsuitable for system l / J <br /> QJ,(ENTIO❑NU . Mil S. ❑Q IN-Gf10US ❑u E: SYYY�� I❑�LH❑�G JQ .R CMVNDE OAllSYSEM:loptional) <br /> I1I�Per SS Il'N D®ESIGN RATE: •'aspti <br /> Al <br /> If Percolation Tests are NOT required If any portion of the teased area is in the /V19under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL PTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> O - 'I51Ms `I- 4S ms b$ -9z$.�mswRtfi&m- <br /> B- I 2 5.1 n1on1E $ <br /> B- 2- 1Z 15.4 F (a(o o- SBllns 8-"(3.KS (ob - 'jZ rlt»su mo <br /> B- .3 12 q5,5 I A16NE (,g 0-'1$Ims '1-b8$.itnsb8• ?z8r+msrlR�mdmdF <br /> O- f.Bbns 6-'128Nms <br /> B- '{ j Z 95.9 Not4t 12 <br /> o• 8 B1ms $-G-N3t4ms 6-7 -7z CiNmsvjRcrrAen t4 <br /> B-S 72 qS.S ll <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEV L-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD( PERI D2 I P PER INCH <br /> P 1 UP t t 3 <br /> P. 2 2 l'8 M a 3 <br /> P- 2 0 / ) r <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 q3.5 <br /> T T <br /> YReVeSfo T1enrtER - x <br /> OTAEP Lor WW >STI - <br /> 1n�Eu. <br /> Z ! +' d- SO0 1►,�._OF# 1380_ <br /> _ TN <br /> DRIVE <br /> , <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 so led in heWsconsin <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 /> 44 <br /> NAME (print): TESTS WERE COMPLETED Olt.' / 3 <br /> RICHARD b PX/Z II- .S - 9.3 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 2 (00 w 3S W SI'� W •S $ 3 36 7115-84k- 96 <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SBD-8395 (R. 10/83) —OVER — <br />