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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 /> 69 <br /> HUMAN REQ TIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATIO SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> 1/ E�/ 5 /T N/R �E (p S F ► 20 c <br /> COUNTY: MAIL NG ADDRESS: <br /> l 2 35 n <br /> USE DAT OBSERVATIONS MADE <br /> �y5 NO.BEDRMS.: COMMER IAL DESCRIPTION: A ESTS: <br /> KResidence ���' Jew ❑Replace / -+J aO /n - �, A 3 <br /> RATING:S=Site suitable for system U=Site unsuitable for system l'J L 1 -I <br /> NV S 011 . "'R EJU IN-GROUND-PRESSURE-�� E: LLrOLDl OES <br /> SZ� .RECOOMMENDED SYSTEM:(optional) <br /> If Percolation Tests are NOT required DESIGN RATE: SS U CC NN�r,,VV,�N,Ir II, r,,I1,- <br /> q If any portion of the tested area is in the <br /> under s. 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 H ST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 $OO $.% NOME_ >`3IB 0 681msb ybRlnsta r �{o $�P�N)r>tsw <br /> B- ?- SS 9t.5 >$S o- INM 1 31YKn o y MJ!SBNrhsw Y <br /> B- 3A <br /> S6qb.2 SS o 6 Irns `� s w . " '�5 rhsw <br /> B 12 q `I, l0 5 '4'5RMSw Y 3' 1z lufxsW v <br /> B-5 72 X10 "I2 c)--Ij&ols -q c6 q% ZZ,pis 63 <br /> B- <br /> PERCOLATION TESTS <br /> lTEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LV L-IN HES RATE MINUTES <br /> T NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I P RIOD2 P R PERINCH <br /> P- 49 1140 o ZYti lis 5 <br /> P- LAU to <br /> P-3 0 <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. OQI000AL- Rf.PLACEMEMr <br /> SYSTEM ELEVATION 14-1 92-3 <br /> ScfotL.E I (00,00 FSS dolF�o _ <br /> r <br /> �O HCR •Lo?,r" -- � _ ; _ ._ _ <br /> Pll t aT uuE� awe _ TN <br /> I y � <br /> 1!' <br /> I, the indersigned, 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 /> Adnyimstrative 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 /> -elC opr.Ns 1 (0- 1 - 90 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> Wf_155TER U01 .54sa3 3(, 015 _%Ilo L4is l <br /> CSJ SIGNATURE:( <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBDZ395 (R. 10/83) - OVER - <br />