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( / <br /> DEPARTMENFOF REPORT ON SOIL BORINGS AND ` SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> HUMAN AND PERCOLATION TESTS (115) MADISON,W X 3707 <br /> S£ N " (R63.09111 & Chapter 145.045) <br /> LOCATIONSECTION' TOWN4��MU41n PA ITV: LOT NO.:BLK.NO.: SUBDIVISION NAME'. <br /> Y, /�/ /T4ION/A l6QOIprIW h / <br /> COUNTY: OWNERS/BUVEH'SNAME. MAI LING ADDRESS' <br /> 9 ' r zt 4SPr J80 / Mv$ .r7i- f1w. St ya [ nrl <br /> USE DATE$OBSERVATIONS MADE <br /> IXReadence N0.9EDHMS: COMMERCIAL DESCRIPTION: 'New ❑ReVlace PROFI LE DESCR IP11pN5: PER O TIOJT�ESTS: <br /> 69r 15'03./ bt. 0{� j tla O <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ICO y�T'ION AL❑� . MOUND. INGROUN®� P❑�1HE'. SY❑ST�.��IN LH❑SG®u : RECOC ODN ✓rSTEM:InP[ional) <br /> If Percolation Tests are NOT required DESIGN RATE. If any ponlon of It,,teased area is In the <br /> under YH63.09(5)(Ii Indicate. Floodplam,indicate Floodplain elevation <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR TEXTURE, AND DEPTH <br /> NUMBER DEIrTH IN. ELEVATION OBSERVED EST. HIGHEST lH C ULUCK IF OBSERVED(SEE ABBRV.ON BACK) <br /> r <br /> ; <br /> 3 D I 7 93 �4ts ist _F / f "Cis / r'c '54 le 3 <br /> B-a 3 toy 7 9 3 "ary111 q " 45' 76Y " C <br /> B-� 4J 3 1 7 93 y 11H s .i"LS /a 'I C 173 fI C S <br /> B Y 0`3 i. oa-- 7 /03 f ,e4L, / rd C 3'O `t C <br /> B-S- W 3 / D 2- / o 3 c"ji It iiiir '14 S c-S - d "C "C S <br /> k;' 103 l"ren4S 17 " 4S fa " it ,'- <br /> PERCOLATION <br /> t .5.PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL INCHES I RATEMI NUTES <br /> NUMBER INCHES- AFTERSWELLING INTERVAL-MIN. PERI t "w 2 PER PER II <br /> P <br /> P.. <br /> P. .1 p <br /> x <br /> P <br /> P- <br /> :PLOT PLAN: Snow locations of percolation tests, sail borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the bort <br /> oental and vertical elevation reference points and show Inch location on the plet plan. Show the surface elevation at all borings and the direction and percent <br /> f Irna slope. <br /> SYSTEM ELEVATION rJa" <br /> �rrG s' <br /> Or Or oar-'r <br /> r <br /> 01 t <br /> Stirtr� <br /> v r e .i <br /> I <br /> tN <br /> I <br /> 711 wy�t IF-1 <br /> - .5� <br /> A Lase undersigned,Co, hereby at certify thatthe son raid tenoned on this form were orae by mein accord y k the procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the data recorded and the location of the tens are correct to the Gest of my knowledge and belief. <br /> NA 7fl t TESTS WERE COMPLETTjEDOPS <br /> ADDRES CERTIFICATIONNUMBEF P NE NUMBER(optional) <br /> �IGN TUq E," <br /> VVVV ` ✓L <br /> DISTRIBUTION Original antl one copy to Local Authority.P Dire tv Owner and Soil Tester. <br /> DILHR-SBD-6395G 02/82) —OVER — Ir, - <br />��� ' <br />