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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (I LHR 83.09(1)&Chapter 145) <br /> LOCATION SECTION:T y p TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SHBOfVi640OLALArM4: <br /> /T '/ 30 /• 01 /11 /HE (0 W 23 ACV-E5 <br /> COUNTY: MAILING ADDRESS: <br /> Jk L ' 10 Sc 120• D56LLC Zta• (00172 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: R FDIC€-UES R TIONS: PERCOLATIONTESTS: <br /> Residence /L �--�— New ❑Replace - prt S - '3 - 92- <br /> RATING: <br /> 1 - 3 _ 92 <br /> RATING:S=Site suitable for system U-Site unsuitable for system 1 L- D I L <br /> O��TI❑U . M��. ❑U ING® S ❑U E: SVSTS I❑UL ❑SG PU RECOMMENDED <br /> ��I 006L <br /> If <br /> If Percolation Tests are NOT required DESIGN RATE: If any Po�orrtiion of the tested area is in the n <br /> under s. ILHR 83.0915)Ibl,indicate: �� Floodplain, indicate Floodplain elevation: IN(j <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALPTH TO GR UNDWATER-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- ) (v0 �.Z NONC > (00 o S51nu S- 7ZSNrhs <br /> B-2 80 NONe > so o LA .61rrv% 4- 80 .130M'5 <br /> B-3 72 (, . � ONS. >72 o - 513tms 5-7ZBNn1s <br /> B- `I 6D 2 N6NC > (00 0 $trns 5 - 6o gNrns <br /> B- -S $0 'j . �E >80 p 9 B(rq s 9 - So gyms <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 P PERINCH <br /> P. t 2.0 is D 3 <br /> P- 2- 2 rJ o t 3i s7 I A/ <br /> T-3 3 0 o iy <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 rcent <br /> of land slope. <br /> SYSTEM ELEVATION R3.5 s <br /> --- <br /> I � T <br /> SCAUL 11`= (b0 <br /> ' ♦5M IOP WAKE 1W AL {NoRWA". . <br /> All_�4 unlEs > 100' <br /> Lc' fAmorj Of flat 7s5 - <br /> 4N <br /> .Vr? ! - <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methoLds s-p.a�fie in the Wis nsin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. pC ,� °f 3 y <br /> NAME (print): TESTS WERE COMPLETED 0 . <br /> ICAP90 14t>Pk-11JS b - 3 - 9 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 217 0 /1�1 33 IJEBSTrrfC c,)1 . 5 893 3670 f5' �IfS� <br /> CS LSIUNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DI LHR-SBD-6395(R. 10/83) -OVER - <br />