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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, PERCOLATION TESTS 115 DIVISION <br /> LABOR AND P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (ILHR 83.0911) & Chapter 145) Asn) 1/r )0 <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: L8F-N9.:BLK.NO.: S <br /> �/ �/ /T 116111/1115 E (.cwi UACKSoN G L.`l <br /> COUNTY: MAILING ADDRESS: <br /> DMROUT pHt4 BfigTLE4 11211DEERT• tJ . 123 <br /> USE DATES OBSERVATION MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: I FI TESTS: <br /> ❑Residence New ❑Replace c'1 - ZZ O' /1 - 2 2 - Q3 <br /> RATING:S=Site suitable for system U=Site unsuitable for system 1 J L� I LJ 1 <br /> O®�TI❑� . �. ❑� ING 1S OU E: S®S I❑UL ❑SOLDI C'®U TAN RECOMME NO ED SYSTEM:('DnIVG�Ifi1nnIALtional) <br /> If Percolation Tests are NOT required DDESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: t�� Floodplain, indicate Floodplain elevation: p <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES ICHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEEABBRV.ON BACK.) <br /> B- 2 77_ 1•2- NONE > Z 0 3115 Z'Z- 7Z '51J 5 <br /> D- 'g ') -2A S za -12 r1 S <br /> B- 3 3 �Z �. � E � Z <br /> B `f Z of - <br /> B- Jr 9 NO ,r > 7Z 0 - Fjlm <br /> � s <br /> B- 2 'l NONE > 72 0 - 'l Pel ms 1 - 17- 3 fr Ms <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. <br /> PERIOD 1 PERIOD 2 P R PER INCH <br /> P- too S ? <br /> P. 22 5 <br /> P- No <br /> 5 / -y a <br /> P- Nb 3 y S <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 to a . non the plat plan. Show the surface elevation at all borings and th irection and percent <br /> of land slope. 9L . -V , // <br /> SYSTEM ELEVATION q5-`I 95 . 1 �(► \ll <br /> T <br /> I <br /> Abm 100, NO—I W 12 DHK S� os sj <br /> fAve a 220[12 b <br /> \��LL_Tog&. _75U fRoN �i� i I <br /> 47 y A <br /> I I <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and melhoA specified in the Wisconsin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the bes of knowle a lief. � y 30 <br /> WqX <br /> Iq <br /> kize <br /> NAME (print): ' t TESTS ER COMPLETED ON: <br /> ST'7 - 7-3 - 9--3 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBERI ptionall: <br /> HAWi 3� o s 86� Is <br /> CSTSIG ATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />