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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.: SUBDIVISION NAME: <br /> SF I/ y /T'iDN/Rl4Eio W Sr-nT 3 NYS �' <br /> COUNTY: MAILING ADDRESS: <br /> -60FINEIT JA kA cT u ) Z 3 ILU �I A Iz \ A <br /> USE DATES OBSERVA NS MADE <br /> ffYYhI� NO.BEDRMS.: COMMER IAL DESCRIPTION: 7111MIL ES <br /> A I TS: <br /> XResidence 2- r�-- xNew ❑Replace I Q _ i7 ,. O � <br /> RATING:S=Site suitable for system U=Site unsuitable for system F L- J �1 <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:R ECOMMENDED SYSTEM:(optional) <br /> 1171S ❑U ®S Oul ®S ❑U ❑S ®U ❑�U10-ONVENTIONAL <br /> If Percolation Tests are NOT required DESIGN RATE: 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 TOTALP H TO GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED E T. HIGHESfTO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 7Z X19 .2 No NE 1Z QD- (o3tm5 C.- 72-st)me, <br /> B-� .O No NE- > 12 0- (o$lim5 (D- 117- Bt- Ms <br /> B- 3 7Z -3N0ME 1l2 0- SU1sMS- `1 <br /> lz3Nms <br /> B- r)P, . S W)llJIL _>_1a (3-�-k 1AmS 6 --12_6wy\s <br /> B-5 78 O 15 l2 <br /> B- <br /> PERCOLATION TESTS <br /> EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER L V L-IN HES RATE MINUTES <br /> i NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI D2 P 0 PER INCH <br /> P- I <br /> P. 2 32 *J/ <br /> Z <br /> 9 <br /> P- <br /> P_ <br /> - <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 �� 3 <br /> �snuE 1=sor oto E.5S Noav-q__ ? <br /> ♦BM 1Aot1 \L(cl 8" FI _ _ <br /> pE4.C. x <br /> • ao1Z� ' , � - � � _ �_ $IRS,N <br /> N <br /> WIRc <br /> FA <br /> w • • n $LOG � <br /> 2 <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 (1 �pj ;7 �( TEST9 - 2-5- 90 <br /> S WERE COMPLETED ON: <br /> IC R 1- K.)lV5 1 - 2-5— 10 <br /> ADDRESS: CERTIFICATION NUMBER I PHONE NUMBER(opuonal): <br /> 1 3�,7o <br /> CST SIGNATURE: <br /> 1 <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. y <br /> DILHR-SBD-6395(R. 10/83) -OVER - <br />