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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> 7969 <br /> LABOR AND P.O. BOX <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 533707707 <br /> (1 LHR 83.0911)& Chapter 145) <br /> LOCATION: SE TION: TOWNSHIP/MUNICIPALITY: OT NO.:BLY-NO.: SUBDIVISION NAMF�tr ✓0 Uc r <br /> S� /r% � /T%N/R �sE 1pr) <br /> COUNTY: MAILING ADDRESS: <br /> r:yrrl.l,d 6,s6 A /- ..;. ' C�iF:jc? Gn/Ju G Sy �L' <br /> USE DATES OBSERVATIONS ADE <br /> NO.BEDRMS.: COMMER IALDESCRIPTION: A S: <br /> Residence '� /I p/ XNew ❑Replace I 9'��� �' <br /> RATING:S--Site suitable for system U=Site/L//A <br /> for system <br /> ONVENTIONA L: MOUND: IN-GROUND-PR S STEM-IN-FILL OLDING TANK:RECOMMENDED SVSTEM:(optional) <br /> ®SOU ®s Du ®S Du DS ®U ❑S MU CONY. <br /> DESIGN RATE: <br /> If Percolation Tests are NOT required If any portion of the tested area is in the ��� <br /> under s. ILHR 83.09(5)(b),indicate: /v/� Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED I EST.HIGHESf— TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) <br /> a <br /> B ��n -3r �u /7671st, / 9 3', ' 9151 /3 / i A <br /> P/ ,. 9 7 <br /> B- 3 �tk "d-rI P? 79� /3/s, r �r1rL <br /> e- `f 9)-y Ham -7L« 65"156 �rlil <br /> B- S 73 j " 7 7� l r r, <br /> B- 65' `7 3u /b r lt�7w > 7Z" 3 �. ' A SA <br /> na <br /> PERCOLATION TESTSON <br /> CO <br /> IJ� E <br /> WATERIN HOLE TEST TIME DR I WA V L-I H S RAPERINCHES <br /> NUMBERS AFTERSWELLING INTERVAL-MIN. P RIoDI P RI D P5 P- / <br /> Pif lip <br /> - <br /> P- tt <br /> P T <br /> PLOT PLAN: Show locations of percolation tots, s it borings and the dimension suitable so reas. Indicate scale or distances. Describe what are the hori- <br /> zontal and vertical elevation reference points and sh w their 10 ti on the + jw the surface elevation at all borings yaand the direction and percent <br /> of land slope. - �oc O/ ' <br /> SYSTEM ELEVATION <br /> g�1 =rim -�o"oukejL c,t,i ', 1/1,utl <br /> { <br /> �M t4 tr.Ct4f �/a� [li*, - <br /> YVI <br /> > 56 {a SL/S�4ri <br /> q u fQ - -- ;r/Z, �i <br /> �(4t fP pi l^eJ 3 41 V19,5, Jut <br /> f N <br /> 7. <br /> rofa.L �q/zrA 7T5?EQ 3.0x YU` yam- t _ <br /> 4 <br /> DA6 <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and a ods s cified inisc 'y <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my li <br /> b 4v E' <br /> NAME (print): ee T S E COMPLETED ON: <br /> �/c� 'c;Tl — c�— <br /> ADDRESS: CERTIFICATION UMBER: PHON E NUMBER I optional): <br /> 57 <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Auihprity,Property Owner and Soil Tester. <br /> DILHRSBD$395 JR. 10/83) —OVER — <br />