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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 /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> N014 E_ '/+ 22/T_/N/R/ E (o0 N A N Ar-2E-5 <br /> COUNTY: MAILING ADDRESS: <br /> 'SVRr EFT E CORN S Bflss LK Ro - E�sTr:(z (• 3 <br /> USE DATES OBSERVATIONS ADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: II ESTS: <br /> %Residence 2 New X Replace L C _ Q ,. [ - Q _ Q <br /> RATING:S=Site suitable for system U=Site unsuitable for system J U J t� l <br /> O NVENTIOjVAL: MOUND: ' EIS KU E: SVO� I1uL RECOMMENDED <br /> SYSTEM:(optional) <br /> � <br /> S fIQ�IU DESIGN RATE: <br /> If Percolation Tests are NOT required 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.HIGHrST_ TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 4o (00. 2 39 ZS 0- 6 Blrns lo- 28 I3sims 29 39 BnlmswReWAfttk 3q - <br /> 13-2 _a,<6 100, 1 310 zb 0-7 Blois �-26 Brims 21= 3�B�smS wRt.wld.MQi aro - WO-V <br /> B-3 3 100.0 3S 2`� 0-Ifilms 7-29 30PI5 29 .358Nm5WKCI li 35-L e <br /> B- 14 -3 100.0 35 ZS 0-7 Sims - 7S Bpjyyls 25-35713Nrv1s.WRcmam-a 5--Wgt <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> E NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p RI Dt PERIOD 2 PERIOD3 PERPERINCH <br /> P- 2`t No S / /p S <br /> P- 2 2`1 0 5 % % i <br /> P- 2140s y Y <br /> P- 2 140 S /Plyy S <br /> P- <br /> P- • <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensionsLn. <br /> able 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 phow the surface elevation at all borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION IoI 2 �X�)NG p2YwLL <br /> Q oil <br /> "DRIVE <br /> _ <br /> Sc.gL F_ I yo'_ q <br /> _ �_ <br /> *BM iop TMMM of 5011 N <br /> > <br /> i - - <br /> PL <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 ITESTS WERE COMPLETED ON: <br /> /21Crliqrzo PO+PK1145 -S -13 - 91 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> WEBSTelz W). 5�f S°L3 3670 I - - I <br /> CS SIGNATURE: <br /> Xj11U4J <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD6395 (R. 10/83) —OVER — <br />