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DEPARTMENT OF RE-PORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY" PER CATION TESTS 115 DIVISION <br /> OL <br /> LABOR AND P.O. BOX 7969 <br /> HUMAN RELATIONS (I LHR 83.09(1) & Chapter 145) MADISON,WI 53707 <br /> LOCATION: SECTION: N E (or)w TOWNSHIP/ y; LOT NO.:BLK.NO.: SUBDI VISION NAME: <br /> �/ BIW'/4 / 0 / J �7 <br /> Cg},NTY: OW" jR'S UYE 'S ME: MAI LING ADORESS: <br /> Cf nt /'Co -e/ T L'4 Q `e- o'�7%0 MqJ, ,- n c' [�-cL c /Ti%.r Al <br /> USE PROFI OBSERVATIONS <br /> PT ONS:AD R OLATION TESTS: <br /> NO.BEDRA°n COMMER IALDESCRIPTION: <br /> Residence �'1 I ®-1Jew ❑Replace _ �_p r - 7 F <br /> RATING:S=Site suitable for system U=Site unsuitable for system U <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYS T EM:(optional) <br /> his ❑II as ❑u ©s ❑u ❑s ®u ❑s ou c Q N� <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09151(b),Indicate: IFloodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL i3rPTHTOGROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSFRVFQ_ EST.HI HEST TO BEDROCK IF BSERVED (SEE ABBRV./ON BACK.) <br /> B- RIO <br /> IO S1010 Q (0 0 s 64,Zr "/e/Mrd S' <br /> 13- 1 pS o y e. I I �. ,.L s ,a., s /e/"4 itis 6A, ..4y9�, <br /> 13-3 b 9Br 3 " 60 w � r [! " �t A/'A%re(SLV &C,/C ,S/a <br /> B-Y 90 q O r(o ` � go S_ V ",6v, r /o " 1 r /a'' •",. �s " <br /> B-T_ <br /> B- 1 M o T <br /> PERCOLATIO ESTE <br /> TEST DEPTH WATER IN HOLE TEST TIME CROP IN W LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. gPERIOD 1 PERIOD2 P R D PERINCH <br /> P-a- I N� �� s2 a S/ _ .__ a <br /> P- d <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 Bfrc ( T7tLd+ l 4` k` <br /> S Gq,� e, It4ert17 <br /> / "=yo ' <br /> ..c_'icccPr T61/. /ave air <br /> wIt*r-*_ I)o s4. T S<-c <br /> ,I <br /> 1 tee• ? . . �7 + <br /> I O <br /> e FY •r't <br /> /loot-} <br /> V/ <br /> I,the undersigned, here certify that the soil tests reported on t is form wer a by nre in ccord with a 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 b t of my kno ledge and belief, <br /> NAME (pri t): TESTS WERE COMPLETED ON: <br /> Q trfcQ KT - - f5- <br /> AD RESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> rip <br /> CSy$IG TURE: <br /> lJ/ti/ <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />