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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, c DIVISION <br /> BO 76 <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (I LHR 83.0911)&Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> I/ <br /> l4 Z$ /T ON/Rja (o0 AKLAw? a <br /> COUNTY: MAILING ADDRESS: <br /> RN�tf le MoRjE11i 1352S BrLgN.9P ,57:, <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMMER I AL DESCRIPTION: F NS: ESTS� <br /> esidence ? /� I New ❑Replace 8 • �/— q3 9- 2 - l73 it — Q3 <br /> RATING:S=Site suitable for system Um Site unsuitable for system G O' L / <br /> ONENTI O❑NAL: MO ND:❑U IN-GROUND Q URE: SYSTS I❑U L ❑SG TANK:RECOMMENDED' SYSTEM:(optional) <br /> If Percolation Tests are NOT required DES IS RATE: If an the <br /> V %V <br /> q y portion of the tested area is in the Alp <br /> under s. ILHR 83.09151(b),indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALPTH T ROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. PT7HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> d'$ IrnS $-Z'] P15 2? -S(o,B M GorgQgcTEo <br /> B- I 2 No NE > 2 tJl 0 S'1 - riJ M PACIN o <br /> o-el$lMs �9 - 32bNt17s 32-,�LZbjricomParc-jYcn <br /> B- 2 z �. NONE -."7z SZ- lsBA-1a - `1Z8N s cctn <br /> gnaso <br /> B- 3 12 D" SBlros S- 2-930os 7--7- I-LBrin 4nPAcT£o <br /> B- 1 I2 NONE > -7Z b -1 dirty '1- 3o 8t4wa 3o -IzBrjw fix pltt,%o <br /> / B- NONE 72- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD R PERINCH <br /> P- I NOy S <br /> P. 2 Ve N Y �/ 2 <br /> P- NO 2/ Z- <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 �$ w <br /> _ � T , <br /> L __. <br /> it 1�11/,�, <br /> 1 l ; <br /> = <br /> � J� W U46.►�1L�It. <br /> l I <br /> I P05E4 <br /> s , d J&DG - t N <br /> l <br /> I <br /> r V l <br /> _a <br /> l <br /> 1,the undersigned, hereby certify 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): TESTS WERE COMPLETED ON: l I r <br /> KicaOpler - Z - <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBERIoptional): <br /> o w .3S LX9STER 813 -56L- IS <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-5395(R. 10/83) —OVER — <br />