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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 /> 612- (ILHR 83.09(1) & Chapter 145) UNOq St <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: BktsOfW91CN'fd'rM24E: <br /> Ar <br /> '/ '/ /T g N/R E ( )W E S c <br /> COUNTY: MAI LING AD DRESS: <br /> ElApiJUT17E53 E 1AF1LLE\/ 12-91103 Tmgusg <br /> USE DATES OBSERVATI NS MADE <br /> NO.BEDR .: COM RCIAL DESCRIPTION: ONS: A N TEST <br /> ❑Residence i/ _ 3 1 � ❑New Replace 9 _ 1/ _ 3 _ II qs <br /> RATING:S=Site suitable for sy m U=Site unsuitable for system I' V! 17 b <br /> ONOVENTI®AL: MOUND: U IN-GDS U E: SVO� IMUL pO SG®U .R ECOOMutio SYSTEM:(optional) <br /> If Percolation Tests are NOT re fired DESIGN RATE: I If an V <br /> q IL y portion of the tested area is in the �� <br /> under s. ILHR 83.09(5)(b),indicate: 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, ELEVATIOl I OBSERVED E HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B-.I 30 •0 044 I'S it 0-1 Slfs 7- 13 N s 13- 315 $hl j c,•tdMo� <br /> B- 2 94.2 0M6 is it <br /> o'`b Blfs $ - 138o�Ts l3' � 13�+fs u R�md.m <br /> O'8 1(0'61& 16 - 2D &fSw Rcm Mall' <br /> B- 3 2� 4• o <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER I HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RIOD2 PER INCH <br /> p- ► Z 3 '141 Ie lift Ply <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 refe ence 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 ELEVATI N 96, q <br /> f 7 <br /> - � U�M-bfG ZDOO app 1 I0a T140VL'_ <br /> Q2 Po — <br /> LL <br /> , <br /> -3 <br /> 1'N <br /> I i <br /> &A1k 1"= .4b r UNLESS 9OMP_ _ o <br /> I,the undersigned, hereby certit that the soil tests reported on this form were made by me in accord with the procedures and methods sp ifiP.din� tJ1e Wis����� <br /> Administrative Code,and that thedata recorded and the location of the tests are correct to the best of my knowledge and belief. �/(�U'd^— <br /> NAME(print : TESTS WERE COMPLETED ON: <br /> R a ,nrs q- I � • q3 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 2-7-760 3S. WE-Bs WI .S` 2i 3 31o70 S IS <br /> CST SIGNATURE: p� <br /> II.NS r I s4MA <br /> DISTRIBUTION: Original and or e copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD6395(R. 10/83) —OVER — <br />