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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> DIVISION <br /> LABOR AND PERCOLATION TESTS ((115) P.O. BOX 7989 <br /> HUMAN RELATIONS \ / MADISON,WI 53707 <br /> OLHR 83,090) & Chapter 145) <br /> l� ATI '/ SECTIO�T�9N/R/6t1e.,W TOWN1FENo 1!� l_�;O.:BLK.f0.: SU130;7;N NAME: <br /> COUNTY: OWNER'S 5"TrRS NAME: MAILING ADDRESS 11 %" /'% <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PR STS: <br /> Residence N,4 ❑Naw Replace I - $ 3 Q� �• ?3' gf <br /> RATING:S-Site suitable for system U=Site unsuitable for system <br /> ONVENTI NAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> MSE161NSOU1 0SFA 1EISSUIE]SOU1 ../.R <br /> DESIGN RATE: <br /> If Percolation Tests are NOT required DESIf any portion of the tested area is in the �� <br /> under s. ILHR 83.09(5)(b),indicate: QA Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GR UN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- i 72 99- 3.r > 7 /8 "ox6„ 1*15 <br /> B- A 7 Q�,-8 " ,r 60 20" S 2 " o= C <br /> B 79 49_ y " ,t , 72 26 ©X AVT 22'k.AW52 ,46 r <br /> B y 72 98'-„' 2 a <br /> B- 6 72 loaf-y.. I/C- D” s AJS J.7., , <br /> PERCOLATION TESTS Q�/11o747 <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RIOD2 P PE81NCH <br /> P- 2 r O liv -3 3 3 <br /> P- l / /O s' i 3 <br /> P 0 L 3Z <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 97 2 <br /> p : <br /> BORE 7,&q CLAN► <br /> O <br /> Q.�► V RP -.ToP OF* TURVsy pipe <br /> ak PF <br /> 5017ASLtAREA <br /> ra <br /> t, FT fuMp RC-0 TN <br /> �T ilk 241 <br /> a <br /> FiRF �R M-(.838 Fl`Li <br /> hhplll�A RD <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 /> 40WAIRD Q SC R 4ffER 7— :7 3 — F' <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 2 3o S! 0 SAeAl W SfRjz �sT aYzi S/i? <br /> CST GNAT14 <br /> DISTRIBUTION:_Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DII.HR-SRn.63g5 (R. 10/83) rnrpn <br />