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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 /> 0LHR 83.0911) &Chapter 145) Z� 2 <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO, SUBDIVISION NAME: <br /> )/ V4. `fl N/R6E (nr Wlss 3a 75IAdd <br /> . l Lea <br /> COUNTY: MAILING ADDRESS: <br /> X0141 L 5 mumitil Av- MN• 5 07 <br /> USE DATES OBSE NATIONS MADE <br /> N0.BE MS.: COMMERCIAL DESCRIPTION: 7—RrFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> ❑Residence I �� ❑New <br /> RATING:S=Site suitable for syi tem U=Site urtsuitable for system �7 I <br /> ON ENTIO❑ MOUND: IN-GRQUND- ESSl1RE: SYSTEM-I N❑-FILLHOLDING TANK: REC�MENDEOD SYSTEM: <br /> Percolation U TEMaoptional) <br /> If ollation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)Ibl,indi ate: r___. Il Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATIC N OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- ) 97— 9q-5 NONE > '72. O- Ip51ms 4- '1zBurns <br /> Z b-6-91A15 6-a built <br /> B- g 96•!o NONE � $y <br /> B 3 97- 9q.5 0 >72- <br /> 6 1 31ms �BNms <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER N HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PERIOD 3 PERINCH <br /> P- 1 20 0c, 5 1 " 1'/b <br /> P- 2 6 NO SI b �! 3 <br /> P- NO /k <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 92-R <br /> �{ tl -- r r - <br /> t LL �I <br /> 0 )f3E_ Q195 - - <br /> R, WELL- <br /> VIE <br /> aLD B <br /> N <br /> o <br /> v <br /> i <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 th data recorded and the location of the tests are correct to the best of my knowledge and belief. 6 1ar..a�S <br /> 9a• <br /> NAME (printl: TESTS WERE COMPLETED ON: <br /> 1CH nizcl Appyws `f" ,4 " 9 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional) <br /> 2't7r,.. >✓ stt i- 91893 3b*70 <br /> CST SIGNATOR <br /> DISTRIBUTION: Original and oe copy to Local Authority, Property Owner and Soil Tester. .41 J" <br /> DILHR-SBD$395 (R. 10/83) —OVER — <br />