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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> 969 <br /> LABOR AND P.O. BOX <br /> HUMAN F3ELATIONS PERCOLATION TESTS (115) MADISON,WI 537073707 <br /> (ILHR 83.0911) & Chapter 145) 0r Vol. S ?6ir 2A <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK NO.: SHB9FV'I9ff9N-NAACG+ <br /> E 1/4 SE 1/4 20 /T N/R)1{ E (p W co 5 N laou wT -45- <br /> COUNTY: MAILING ADDRESS: <br /> 4tfft CUFTISLR 2 KNOWL R. SFII EX 1 "7 <br /> USE DATES OBSERVATIO SMADE <br /> NO.BEDRNTa: <br /> FICIAL DESCRIPTION: IPROFILE% STS: <br /> Residence 3 /�/ $New ❑Replace 3 - b - Z q/7 <br /> RATING:S=Site suitable for system U=Site unsuitable for system VJ l� <br /> C9f�y,ENTI AL: OU S.❑U IN GrNn ❑� E: SFSiEM-I�ILL OLDING TANK:RECOMMENODOED SVSTEM:Io'Io51�U t <br /> SS UU DESIGN RATE: S U OS U N M1 C <br /> If Percolation Tests are NOT required �/ If any portion of the terted area is in the <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED H TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) <br /> B I 0-5 Buns S--SS&rns SS-S'7 & M W F- <br /> f4 moi( <br /> 0 913. 1 NONE 55 51- &0 e- W fZCfA&M0jr <br /> 0-6`J�IMs C0-57TWVrls 5-7- (DI Boft15N -C rrivft <br /> B-2 (os `18.2 goNE I— �W �f.,dwletS <br /> B Mori 51 <br /> p-✓o$IGfiS (�-•�°I Sams SSI- bz Brrr'15W M <br /> �-(P$Ifst1 {o- Sf pvf"RS S{- BN Ms <br /> B- `f (00 91- D o f 'S1 - o e w wl <br /> B- 5 D `). ADN 5 2 S� - SS Nms W {rf Mo <br /> c yJ crr <br /> B- <br /> PERCOLATION TESTS <br /> YDEPTH WATER IN HOLE TESTTIME DR I WATER L V L-INCHES RATE MINUTES <br /> F NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RIOD1 PERI D2 P R PERINCH <br /> P. IG <br /> P- Z r y `i <br /> P-.3 L3D ys S <br /> P- <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- <br /> zontal and vertical elevation reference points and show their location on thelotplan. Show the surface elevation at all borings and the direction and percent <br /> of land slope. ORIGINAL- 'RCQLA(rMW_r <br /> SYSTEM ELEVATION G 9s• q `' <br /> , I <br /> 4 r9�ROX. /90' <br /> SceL,E 1'40'V144S$ N6}Ep <br /> vt IK .L�M1'1 IQO NISI L-IIJ Llor� `0�_�1K, <br /> ,WJ LL TO.3E,_>S�� F�O:YI. Dv� <br /> TN <br /> Q <br /> 0 <br /> _A I _ . <br /> 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methodsupecifie�irlthe 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. `..� '74. f <br /> NAME print). TESTS WERE COMPLETED ON. <br /> 1c A D OPK rLS _ I S- Ib- 9'Z <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional) <br /> 2-?7&c3 W . .S WaST�R W 1 . S $ 31070 '71S-16 6- yIS <br /> CST SIGNATURE: <br /> AA{ K/,I , <br /> x"„_ <br /> 'RIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> I-SBD8395 (R. 10/83) -OVER - <br />