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T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, <br /> INDUSY, DIVISION <br /> ,LABO ' A CP.O. BOX 7969 <br /> HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (ILHR 83.0911) & Chapter 145) <br /> 07 4 <br /> LOCATION: SECTIO%T �pN/R IyE (or TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> COUNTY: MAILING ADDRESS: <br /> C Co- R d 8 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEORMS.:1COMMERCIAL DESCRIPTION: ar,�( PROFILE N A STS: <br /> TS a .dence ��/ ❑New D Replace I t3- 2_q - O 3 C`-2,1 - is <br /> RATING:S-Site suitable for system U=Site unsuitable for system / •J l l J l IJ <br /> ONVENTIONAL: MO ND: IN-GROUNDYR LIRE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ❑S U S ❑U ❑S U ❑S mu I ❑S U JNt� <br /> If Percolation Tests are NOT required <br /> DESIGN RATE: <br /> 4 If any portion of the tested area is in the n <br /> under s. ILHR 83.09(5)(b),indicate: /• a, Floodplain, indicate Floodplain elevation: Nn <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 EST.HIGWE—ST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> 0-15115 1- 34 8-AS 39 - 'H DOS W P cmdm <br /> B- I `{8 104-- NOME 31 44 . cwRcvnbw1P <br /> 3$ 0- I BUSS y�35 8015 35 - 40 B.J Is NRc.rrldtgn <br /> B- 2— 44 �D2.9 Na NE <br /> B- 3 0. 4 1511.)1511.) $- 30 8te1s 30- 42 3Nms Li Z— t.lrrls wRc.f M <br /> SO <br /> (�y. g NONE 48 `18-5'99'W R-MeLmalt <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME I DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD1 PERIOD2 R PER INCH <br /> P- I 'i o 5 :� 'I'll. ",/A LA <br /> P- 2 o L S78 `L/ 3 <br /> P- <br /> P_ <br /> p- <br /> P_ <br /> PLOT <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. <br /> SYSTEM ELEVATION <br /> T" <br /> t <br /> - - <br /> I <br /> IN <br /> I <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 Wisconsi <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 /> S ' <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 6o w 6Bs�R W( - `f8 3 3� iS-SI,6- S <br /> CST SIGNATURE: � _ <br /> DISTRIBUTION:Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SBD$395 (R. 10/83) -OVER - <br />