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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, . DIVISION <br /> 7969 <br /> LABOR ANF7 P.O. BOX <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 533707707 <br /> (I LHR 83.090) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIPI MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> '/5E '/ /T`IO N/R Ib E (p )W aA Q <br /> COUNTY: MAILING ADDRESS: <br /> Wi MC EN 3 EB I LAX a s <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMM R IAL DES RIPTION: SAT E T <br /> •Residence n ❑New ®Replace I A _ '� – �Q l Ip <br /> RATING:S=Site suitable for system U=Site unsuitable for system –1 O Iv <br /> CON❑VENTIONA L: MOUND:V� IN-G❑S •Q E: SVGS I®UL OMSG❑I .R H OOLMENDEDSYSTEM: <br /> ANIC:(optional) <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09151(b),ino I 11� I I Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED H T TO BEDROCK IF OBSERVED (SEE A BRV ON BACK.) <br /> p- � Is b- BN MS i I 14- 3oPt <br /> B- l q�• I 22 2Z <br /> D- 'IB 5 �- 23 MS I I 23-30 <br /> 13- 2 30 99•`I Z`f 2 <br /> B- 3 3p q•5 2`f 2 <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> CTEST DEPTH . WATER IN HOLE TEST TIME D I WATER LEVEL-INCHES RATER INCHES <br /> f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. —PERIOD I PERIOD 2 P <br /> P- <br /> P- <br /> P- <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 �t1he surface elevation at all <br /> (bbooLrin�g�s,aan-�d!rthhe direction and percent <br /> of land slope. 5C L15- 111% qOv vmbjwJ K4,90 <br /> SYSTEM ELEVATION ASK 100 •B0109 Of ROUSE 51011 <br /> J <br /> 'Di2iuE <br /> N <br /> � <br /> o •.. .- . •. v- ._ r -t <br /> trot i-u✓E <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 specified 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: <br /> �IC+��}� Flonlo - 3 QO(QZ) <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> WI 5`f 5 3(-70 1,5' <br /> CST G ATUR <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHRSBD6395(R. 10/83) –OVER – <br />