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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDING <br /> INDUSTRY; DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> 3707 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> II LHR 83.0(91y)S&Chapter 14�5Y) <br /> LOCATION! SECTION TOWNSH PPV: DT7BLKNOS/ <br /> B oSI/OVicejo,%/Mri�.Aj� L <br /> CO NTV: MAI LIN ADDRESS:ndu - //1��cani�c/Wi. •3z�/'7{" <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: TS: <br /> Residence xNew ❑Replace / / '/O�9 1///7,/9( <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> C0 �TI❑� . MOUND:�� O� IN G0 ❑� E: SVS❑TEM-IN-FILL O❑LDING TANK: RE 9��/� $VCn� pptional) <br /> S U U C 0 74� <br /> If 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)(1 indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL P H TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, EL/E�VATION "OBSERVED T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> e 7(0" �r0/�e > 2(y „ 3�' x ;38 7Co" rr s <br /> B• J/ 7�0 9�. `f /t�0/�e > 7l0 O 5111&15/,. �/;,_ y/„ �, /"- 9lo'�I mad. s <br /> x O� e > 1-1Wllne�fs3; 3v�q✓""--76P mrd -5 <br /> B 76'zf� m599 / / � <br /> B- <br /> PERCOLATION TESTS <br /> „yRNUMBER <br /> DEPTH WATERIN HOLE TESTTIME D I R V -I H S RATE MINUTES <br /> f IN�CCjjH���'ES- AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD 2 P PER INCH <br /> 5rj, ()nt '3 O/7 /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. <br /> - <br /> � I <br /> 4 /h LxJ�e of/U Gni- <br /> I <br /> 'Q .Pec..... • <br /> � TN <br /> _ - off. <br /> 6V Q <br /> I <br /> B5n °a <br /> 1, the undersigned, hereby c tify that the soil tests reported on this form were made by me in a ord 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 /> A <br /> DDRESS: � CERTIFICATION <br /> NUMBER: UMBER ions <br /> ,/ T � 7/IX � eJ � /,� .1 X <br /> CST SIGNATURE::: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. N / <br /> DILHR-SBD.6395 (R, 10183) — OVER — <br />