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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, PERCOLATION TESTS (115) DIVISION <br /> LABOR AND P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> 0LHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> --/t-- �/ /T*N/R1GF, W ORKLA D 32 NA pgRD� Rhea <br /> COUNTY: MAILING ADDRESS: <br /> BROM C71LLIS ORG1 I 553Is <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION:❑ U R NS: A ON TESTS:Residence �2 r� ❑New IjgReplace �/ �n - p.L 22-- 9y <br /> RATING:S=Site suitable for system U=Site unsuitable for system ,,--/, 1 L 1 [.. <br /> (Z S <br /> ONVENTI❑U . N1��. ❑U TI ❑U E: SV�� I❑UL ❑SGl�L1U R r-n Ni VcNTDh1AL MMENDED SYSTEM:(optional) <br /> If Percolation Tests are NOT re uired DESIGN RATE: <br /> Q If any portion of the tested area is in the <br /> under s. ILHR 83.0915)(b),indicate: J`-�— Floodplain, indicate Floodplain elevation: NA <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D P H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPFH IN, ELEVATIGN OBSERVED EST.1411HET TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> illoo.Q NONE >`tZ. D-SBIrns S-?7-&Ins <br /> B- 2 '1Z qj.j rloNE !','7Z 0-40151WLS (V- 1LBNrns <br /> B- 3 r72 40KE >72 o - balms 6. '128Nms <br /> B- <br /> B- <br /> B- <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 PERIOD 2 PLRPLHFUU J PER INCH <br /> P- I Z No S <br /> P.2 2 r4o 5 2- <br /> P-3 <br /> - <br /> P-3 A0 5 13/ <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 qS.'7 <br /> s0, I <br /> I ♦$MIIN <br /> loa -NAI� '13'REv oAx- <br /> WFl�`foR`ly ljEu <br /> PRot�sfn <br /> PO IA5 - - -- <br /> 20 - <br /> it <br /> I 3 <br /> i <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> NAME (print): TESTS WERE COMPLETED ON: <br /> I(HAR0 Appews G - 22 -q2 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 2-'7SS WES5T6r WI . Sq$ 3 3(0'10 Is 866 /sl <br /> ' CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBO-6395 (R. 10/13W -OVER - <br />