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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) 61z- <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: :gym <br /> Y Y, /T�{ON/R�b E I fl u. 3P 10-3 <br /> COUNTY: MAILING ADDRESS: <br /> M 139AU q fk Avc , ST- ? OL, t 0 <br /> USE DATES OBSERVATIONS MADE <br /> �{, NO.BEORMS.: COMMER IAL DESCRIPTION: Imo- ReplacePROFILE DESCRIPTIONS: PERCOLATIONESTE: <br /> 'lSlResidence �l ��- 1[y New ❑ LI- �"'/- LI - )'7- G I <br /> RATING: S=Site suitable for system U=Site unsuitable for system / / l <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLOLDI NG TANK:RECOMMENDED SYSTEM:(optional) <br /> ZIS ❑U ZS ❑U ®S ❑U EIS ®U ❑S 50 <br /> CoNVEn1T�oNAt, <br /> If Percolation Tests are NOT re uired DESIGN RATE: I If any y portion of the tested area is in the <br /> Il <br /> under s. ILHR 83.09(5)(b),indicate: tom_ Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALPTH TO GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHFST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- ) a5 NoNE > ?Z O- 4 $ImS 4- 7z 6Nms <br /> B- 2 ,4 90NE > ?Z o- y81(nS `4- ?2BUms <br /> B-3 15 4.0 > 75 0- 4Bim6 14-77- ►.mss <br /> B- 4 ?2 O '>11 0 - `181ms9- nhjft <br /> B-5 72 9 2 .9 > Z 0-gB1ms %A-72-15wrl <br /> B- <br /> PERCOLATION TESTS <br /> 1TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER L V L-IN HES RATE MINUTES <br /> i NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p RIOD 1 P RIOD2 P PERINCH <br /> P- 1 3 )AP '+-� 3 <br /> P. 2nl 5 311-4 <br /> P-3 1 y / <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 D • <br /> 611 190 #cTloti- 0f _5 JN.G : <br /> GULL_ Bw� FIGl } Sg3o <br /> N <br /> 1Q7a <br /> 5 r <br /> PL <br /> I, the undersigne , hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified 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. ;re g a ., <br /> S . `1a <br /> NAME print : ••,,CC TESTS WERE COMPLETED ON: r <br /> RIGHIRK-P �� l�7 q - '7 - l <br /> ADDRESS: CERTIFICATION NUMBER PHONhE NUMBER optional): <br /> (vEssr�x i 5`fS93 o �5- ��- is <br /> CST IGNATURELl: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBDb395(R. 10/83) -OVER - <br />