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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LA80R AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> P.O. BOX 769 <br /> HUMAN RELATIONS <br /> (I LHR 83.09(1) &Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SL�9BH4S✓•9N-TCfrME: <br /> �'/5 '/ /T`o N/11N E to W X 12 hcj&s <br /> COUNTY: MAILING ADDRESS: <br /> 7(05 gbT ST. 1wN U W " <br /> USE DATES OBS NATIONS MADE <br /> NO.BEDRMS: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: A IONTESTS: <br /> Residence [^�� New ❑Replace <br /> � 'Z 15-22-qZ 5-22'92 <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> NVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDI NG TANK:RECOMMENDED SYSTEM:(optional) <br /> $ ❑U M$ ❑u �$ ❑� W$ ❑� EIS tKU C�+J✓FnlrindAl_ <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> 4 If any portion of the tested area is in the <br /> under s. I LHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: NA <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GR UN DWATER-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- 10 111 0 NONE ->(p o 513IIs 2 z - o 130m5 wyf <br /> B- 2 ZO 2 Qt jf' 12Do- ( $Its 6-z8 c- 2% I'Zu '> ,jms WC ✓ <br /> B- 3 N� , (0 o- ��Ils b- ZD �� ZD- qIo SNMSwS✓ <br /> B �S 2 tJDrJE ��S o'S811s 5- 14 Kc 11-* $S B�M�� ✓ <br /> B-S _ao 100. 0 NOE ,rLo o-��ll� b-ZyiZ� 2y -1Z� r�ms�y,� <br /> B C► �� �o �>✓ Mov�b a 5uft H kAU*0 TO MaT <br /> PER 0 ATION TESTS LIQ!" <br /> MAX . Covek, <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PE RIOD2 PERIOD PERINCH <br /> P- I ZNo0 4 z 6 <br /> P- Z ONO0 S y b SI <br /> P- 3 5q No <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 60/ UNLESS WEP <br /> HPRox�f� <br /> >SD , <br /> orNEa LOT unlEs > ldo <br /> s yJElIToS� 'SD_E2oM &� <br /> QRoPas� tz- <br /> N <br /> QRoPoSTD <br /> C3 <br /> a2 ; <br /> �rE <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and mer Tied in a Wi on in <br /> Administrative Cade,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. 'X 6o v <br /> %3.3y <br /> NAME(print): TESTS WERE COMPLETED ON: 7ptional):ICH i N "Z2_ , C)Z^'CRESS: CERTIFICATION NUMBER: PHONE NUMB-77 w� S E t2 1. blS 6 <br /> �a CST IGNA URE: <br /> )riginal and one copy to Local Authority, Property Owner ana 500 Tester. <br /> (R. 10/83) —OVER — <br />