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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, - DIVISION <br /> LABOR.AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> ((LHR 83.0911) & Chapter 145) <br /> &71a 0 <br /> OCATION: SECTION: TOWNSHIP/Nldlfl9YiMtYli.Y: OT NO.:BLK NO.: SUBDIVISION NAME: <br /> '/ �/ s- M/b N/R/sglo so 1VA <br /> COUNTY: MAILING ADDRESS: <br /> TT iAM /H/nAGE STN.P RT. noNe/P mo of <br /> USE DATES OBSERVATIONS MADE <br /> ������ NO.BEDRMS.: COMMER IA L DESCR IPTI ON: rrte�,�// I1� A ESTS: <br /> L"JResidence L7New ❑Replace <br /> RATING: S=Site suitable for system U=Site unsuitable for system ~7 0 <br /> ON�V.E�NaTIONAL: MOUND: <br /> IN-GROUNDPRESSURE: SYSTEM-I NTLI Ell <br /> TANK:RECOMMENDED SYSTEM:(optional) <br /> EIS ❑U E J LJU �U ❑S UU ❑S PC CaN4161,(Tio1vA L <br /> It Percolation Tests are NOT required DESIGN RATE:� I 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 TOTAL DEPTHTOGROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED H T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 9 96• P NONE BA 9 XS RXes F S% <br /> e 7,-- 971 72 <br /> B-3 1 73 > 7 j pK s TT 3 Is D <br /> B- T '� �S 7 g 7s S /y Z 0 A MED, S 63 <br /> B-- 7;-- 9�• 7-7, s T le arlsor o <br /> B- <br /> PERCOLATFON TESTS <br /> ti EST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> f NUMBER INCHES- AFTERSWELLING INTERVAL-MIN. p R t PERIOD 2 P RJ PERINCH <br /> P- NO 3 a / <br /> P- 3 No 3 3' <br /> P- J 7 A0 <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 95!L <br /> ROAD <br /> �RMLNO �(tUEL - _ <br /> t�4T /pRoPBlt7'y , pRt <br /> w <br /> Ab <br /> Seto W 1 . . .- - <br /> . <br /> k o• � I <br /> -47 - 8oRt I t✓p7Ep y <br /> V <br /> Q. <br /> A A�LcuAr"Oty <br /> AZ <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by mem 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 /> ADDRESS CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> T S E� C,Ike . Sg'F17 <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. - � <br /> DILHR-SBDb395 (R. 10/83) — OVER/— <br />