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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 /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> I/ y, 6 /T N/R E (p p NpN4 6,129 <br /> COUNTY: MAILING ADDRESS: <br /> ECC sqpts <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMM R IAL DES RI PTION: A ESTS: <br /> Residence �' ❑New Replace -fe 00 5-/I -(2p <br /> RATING:S=Site suitable for system U=Site unsuitable for system O !J I <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE -IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ❑s I Zs ❑u osMu os u ❑sou D VAJD <br /> If Percolation Tests are NOT required DESIGN RATE: 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 TOTALP H TO GROUNDWATER-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- o fsA ,� b Zf Z&Xv uHd s- <br /> B- Z 36 I00.7 ,uou-- Z4 08 s -26BA)1s o9A1hb)xcMdeid '30- 34 Rif- <br /> B- <br /> cB- 34 loo.iAVA5 7S - s5- - ! - e- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> STEST DEPTH WATER IN HOLE TEST TIME DR I WATER LEVEL-INCHES RATE MINUTES <br /> i NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RIOD2 P PERINCH <br /> P_ r 2 N� Z3ia lye 3/ 141 <br /> P- Z Z"If O 54 6 <br /> P- Z 2 / <br /> P- 0 30 <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 nd percent <br /> of land slope. T <br /> SYSTEM ELEVATION 101. 7 22: <br /> I K <br /> CDIJti1 <br /> f {�lKE GARAGE f <br /> BLDG . ,Wel £ <br /> TN <br /> - , <br /> .75o I'.tf, Q, _- <br /> n PERI. <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 /> ADDRESS'. CERTIFICATION NUMBER: PHONE NUMBER(optional), <br /> 5 li3 36 0 .s - �sr7 <br /> CS=: <br /> F L7— <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-63951 R. 10/83) - OVER - <br />