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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) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK NO.: $UBD VISION NAME: <br /> 1(J '/ E '/ 33 /T oN/R Ib E Ip o HKt R N 3 A) N <br /> COUNTY: MAILING ADDRESS: <br /> 'bVRNE7F -Poo sPoo 23 Su- CRA Geo S I 35 /z <br /> USE DATES OBSERVATIONS MADE <br /> rsdNO.BEDRMS.: COMM R IAL DESCRIPTION: 'TS: <br /> Residence1 2- ��� ❑New Replace ( _ 21 _ �G / - <br /> RATING:S=Site suitable for system U=Site unsuitable for system V� / O b <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL OLDING TANK:RECOMMENDED SYSTE :(optional) <br /> S ❑U $ ❑U $ ❑U ❑S U ❑$ U I ckw_ <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> q If any 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 FOBSERVED <br /> R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION HE TO BEDROCK IF OBSERVED(SEE ABBRV.ON ACK.1 <br /> B- 1 2 q`6 > 72 0- 681 5 6-30315 30-?2.Rms 1' <br /> B- 2 72 1$'q > 7120 -5NIs 5-326015 32--7ZQ 5W r <br /> B- 3 2 $-3 -7z o-(661 IS 6-3(o�Nls 3e -17-12-M5 0r <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LV -IN H S RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PqRIOD1 PE <br /> RI PERINCH <br /> P- 2(0 10 P- '1 W 10P- 2 S <br /> P- <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- <br /> zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all bori igs;and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION q6. :5 <br /> I-st, - <br /> SCALE 1" 10' <br /> S7 Oke G4 f- SID <br /> AIM'I00PAIL lfJ2Q" ED 0pk <br /> a PERI <br /> T RtV <br /> 1 3 tH <br /> —FROM'56a RparT100- D UI! 5 <br /> LAKE <br /> old exslsT) <br /> 6�ef�ar - <br /> LvT UNC -- - --- - <br /> the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> NAME print): TESTS WERE COMPLETE ON: <br /> P-HAVD - 27 -SS <br /> ADDRESS: CERTIFICATION NUMBER PHONE NUMBER(optional): <br /> WEBSTE2 W 15`f$ 3670 IS-gbb- Is <br /> CSTSIGNATURE: y� <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHRSBO6395 (R. 10/83) —OVER — -- <br />