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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,W1 53707 <br /> (91ov't_ L oT (ILHR 83.0911)&Chapter 145) <br /> LOCATION: SE TION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> r 4---'/ /T qQN/R ISF lo )W 0 — — — <br /> COUNTY: MAILING ADDRESS: <br /> '150RI46T 3 6,2 LARP614TEUP, AV•Nlf L_NooO o <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: R F DESCRIPTIONS: A ION TESTS: <br /> ❑Residence 2 ❑New Replace <br /> L- $ ' Z? - oil $ - 21 - Cj2 <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> O ENTIM , N-GREIL K71S MSOUMSUJA <br /> N .REMMENDDEDSYS (optional)� ❑ CmL <br /> If Percolation Tests are NOT required DESIIG-NRATE: If any portion of the tested area is in the <br /> under s. I LHR 83.09(5)(b),indicate: ( -- Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATIGN OBSERVED ES HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- (DD �.y nj 04E >600 0 - (a 8(rris 6 - (00 Sams <br /> B- Z q0 qq.0 NOnit >90 0 - b LSIms 6 - 90.6wrl5 <br /> 13-3 (oa 6.3 NoNE > (oo 1 o- 431ms (,- (,oa*irns <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD2 PERIODPER INCH <br /> P- 1 22. 5 11c 3 <br /> p-2 53 I `/,- <br /> P. <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 E EVATION 916 <br /> T <br /> CD <br /> ( <br /> $4UG <br /> M . <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 s Ified in thhee Wisconsin <br /> Admi istrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. `%�lJd *550— <br /> NAME (print : TESTS WERE COMPLETED ON: l 2 <br /> icN oPk/nIS g 2_7 - 9S <br /> ADDRESS: �� (0� W ������ CERTIFlC rT NUMBER: P ONE UMBER(optional): <br /> c0 ( - GG <br /> CST S N TURF: <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SBD-6395(R. 10/83) -OVER - <br />