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MENTOF REPORT OWSOIL' >BORINGS AND SAFETY& BUILDINGS <br /> INDUST `DIVISION <br /> LABOR AND PERGOM�q, TESTS /r115\\ P.O.BOX 7969 <br /> FRJMAN RELATIONS 1 / ' 1MADISON,WI 53707 <br /> (11 'Chapter145) <br /> LOCATION: SE TION: TOWNS'IP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION.NAME: <br /> s '/ ,•'/ /T3 N/R IBE (or TRa � �G�:• ;. c o d � <br /> COUNTY: O_WTNER'$ BUYER'S NAME: <br /> lw" e LkPft o <br /> USE I <br /> DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL D $ RI TI N It7� PROFILE DESCRIPTIOR97FrRUOUC�rR5WTrrrg.—I <br /> WResiqence / W1New ❑Replace p <br /> 2�Z NQ/Y4., <br /> RATING:S-Site suitable for system U-Site unsuitable for systemM'� <br /> ONV N 1 NAL: MOUND I' IN-GROUItL RE:S S Fi ILI (O( L��DINGTANK: RECOMMEN/D�EEDDSYSTEM:loptional) <br /> w �� �� ❑" ®" ❑S ®� ❑S "®U' 11VS �U 1.�R1111�7,/A � ll7" <br /> hr L, <br /> If Percolation Tests are NOT required DESIGN RATE: I If an <br /> IL y portion of the tested area is in the. <br /> under s. ILHR 83.09(5)(b),indicate: PJB( / l�fF Floodplain, indicate Floodplain elevation: -N 4 <br /> PROFILEDESCRIPTIONS <br /> BORING TOTAL <br /> NUMBER DEPTH IN. ELEVATION PTH TO GROUNDWAR-I <br /> TENCHES HARACTER OF SOIL WITH THICKNESSOL <br /> ,COR, TEXTURE, AND DEPTH <br /> OBSERVED ST. I HEST_ TO BEDROCK IF OBSERVED (SEE ABBRV ON BACK.) <br /> B- / fir, 7.7 may— , .Si— 7 <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCO,�ATION TESTS <br /> TMT DEPTH WATER IN HOLE TEST TIME 3,. .,, IN WATER L V L-IN HES RATE MINUTES <br /> NUMBER INCHES AFTER SWE LLING INTlERVAL-MIN. RI D PERINCH <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 aro 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 percau t <br /> of land slope. <br /> - SX TEM-ELEI.ATION I. <br /> s I I <br /> 7�oL sEt�d = T�ivlYc�� ,tiY µo�s� �n•� <br /> oKFrvj�- ivar INS N � ew . _ . tY.Ae <br /> f <br /> ._ LTL <br /> 1,the undersigned, hereby certify that the soil tests reported on this form weramed0 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'test,s 6re+Cflrrect to the best of my knowledge and belief; 31, <br /> Yf, <br /> NAME(prior): <br /> TESTS WERE COMPLETED ON: <br /> ADDRESSSS:: J. r h! L ry <br /> r 7 <br /> ERTIFIC3ON <br /> ATINUMBER: PHONE NUMBER!optional): <br /> C-f� l2 L T/' �_ ' T 7." ' fr - L44f1 <br /> CST SIGNATUR7E::. <br /> DISTRIBUTION:Original and one copy to Local,Authority,Property Owner and Soil Tester. <br /> DILHRSSD-6395 (R. 10/83) —OVER— <br />