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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 /> (I LHR 83.09(1)&Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: T NO.:BLK.NO.: SUBDIVISION NAME: <br /> 1/S �/ /T D N/R( E (pr)W eRs 9alot <br /> DUN ' F <br /> MAILING ADDRESS'. { ^^ <br /> � <br /> V <br /> USE DATES RVATIONSMADE <br /> �ry <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: PERCOLATION TS: <br /> g Residence ? �� )<New ❑Replace (D' / �^ I , - q0 <br /> L —I <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL:❑ M°�l ND: ❑U IN-GLAND�URE: SSTEM-INFILL O�ING�NK:RECOMMENDED SYSTEM:(optional) <br /> S U ®S S U DS <br /> U S U C I <br /> If Percolationjests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: l� Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIZTH_EST_ TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B ) so 91- 4 0 E > So 0-(015Iw- 6- $0 Rrns <br /> B- ,2- 2— ` 6.5 40n E 70 O 5- M Kins lo - 12-Etc& wAcrrili <br /> B- 3 NonlE > 7S 0 -5316S 5- 5-Rms <br /> B- 'i $o . AJOE <br /> B- s 2 6q - 4vmi5 (0- s <br /> B- <br /> PERCOLATION TESTS <br /> Y EST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> f NUMBER INCHES- AFTERSWELLING INTERVAL-MIN. P RIODt PERIOD 2 P PERINCH <br /> P. ) 0 3/ 3 <br /> P- 2 3 -5/11 t 3/ <br /> P- <br /> P_ <br /> P_ <br /> P_ <br /> PLOT <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 ELEVAT N ( q .O <br /> DRioF <br /> Sc,R> .E I"= for <br /> ♦BM1co NAL tN ?OWIEKlO <br /> 4 - _ <br /> R1 i, _o7Nr;2. WT L. R S t"5to` <br /> Z WEU:To $E_>50�FR.oM '6F- <br /> vRo <br /> FIRE 42S"y'i T N <br /> _V . <br /> '7 :S <br /> I <br /> I <br /> 1 �I <br /> I, the undersi ned, hereby certify that the soil taIrs reported on this form were made by me in accord with the procedures and methods specified in the fNisco n <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. / r -� Onn}/ry'{'y/'/�,'�� <br /> 3r,5IP�CI!-¢�l <br /> NAME print : TESTS WERE COMPLETED ON: <br /> 1C I �lo�Kl�f __ - o <br /> anDRESS: CERTIFICATION NUMBER: PHONE N MBER(optional), <br /> C IG ATURE: <br /> i <br /> DISTRIBUTION: Onginal and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SOD63951R. 10/831 - OVER - ✓"� <br />