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DEPARTMENT OF REPORT ON _SOIL BORINGS AND SAFETY & BUILDINGS DIVISION <br /> INDUSTRY, c <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LROCLA,T�s€1� SECTION:T '• u/o 15 (or) OWNSHI !MUNICIPALITY: LOT NO.:BLK.NO.: SU DIVISION NAME: <br /> COUNTY: � 6IOWNIA B ER'S NAME S �6 <br /> 14 1 n1. 7yT-7o by /d /1/ <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRNIS.: COMMERCIAL DESCRIPTION: PROFIL DESCRIP IONS: PERCOLATION TESTS: <br /> Residence x\Iew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system o L• c+ /` <br /> NENTIO❑NA L: MOUND: ❑� IN-GROUND [:] URE: S❑S IKuLHO❑LDI NG TANK: RECOM N SYSTEM: optional) - <br /> underres. <br /> Polation Tests are NOT required DESIGN ATE: If any portion of the tested area is inthe <br /> If <br /> 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, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 95 <br /> 76' <br /> B-3 1 f, (7s01_ � 0 tV.) <br /> B g r�f ND '� y �i i3 Didn <br /> r <br /> ell <br /> 11 <br /> 6� J J �v' t, <br /> B 7z'�qS '"7 o nsv L,I S 1 � 13 n <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH <br /> P T <br /> P_ 2 3 7 <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 <br /> IV rQ'I ( f 0IOMnP�. <br /> assn �.� < !G✓ =4 ;&) <br /> sce`PP`o)' <br /> SCA [e, OS iv04ed N <br /> 1 / 2 <br /> -1-1%r4 ARF NG rgu,�C� I✓!�S • a <br /> Of Fell u� -fy►tS /a�. V : Z 3 2 o' <br /> 15d �v /ve15 i,III -ii Wel/ <br /> �f as '3 2 K g ia5 q)CrroX <br /> ee- <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with tfie 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. .72T`��{pY/afXgo � <br /> r 9a-sa <br /> X�e----- jjoesf SE, <br /> NAME ip int!: (TESTS WERE COMPLE N: <br /> ADDRESS: f CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> CST SIGNATURE: yt <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-63951R. 10/83) —OVER — <br />