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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNS HIP/MtINtCfYRtfT'9: OTNO.:BLK-NO.: SUBDIVISION NAME: <br /> f_)'f''Y4/V J% 3 /T?N/R/�E Ip /77eer Tov11?1hr, — <br /> CD7Uine7t Vel h PbiP/�cv� ��l010 0///9G�1P6 �e� 11L7 __)W/5 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: /1 / ( T nE—STS: <br /> 71 <br /> Residence gNew ❑Replace ( /U�e (J �'1�/ <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CON❑V STU: MND:❑� IN-GO N6RE: SVSOTEM-INFILL OL❑DING TA K:RECOMME�ED SVSTEMaoptionall <br /> If Percolation Tests are NOT required DESIGN RATE: SS U If any portion of the tested area is in the <br /> under I. ILHR 83.09(5)(1 indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALP HTO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHE TO BEDROCK IF OBSERVED fSEE ABBRV.ON BACK.) <br /> 13- <br /> 5, <br /> 5, 15;/60"-33 2,67 31'1 <br /> B <br /> CJAI 2fr�0f5 " <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> YTEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER L V EL-INCHES RATE MINUTES <br /> i NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I aPEO P R PERINCH <br /> 5P-p- <br /> P. <br /> P_ <br /> PLOTPLAN: 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 /> _ r <br /> 6,11=iao f(x?6Arn2,-i, x1a.l <br /> /n box off' e%/r c"Z;/e <br /> 1, the undersigned, hereby certify that the soil tests reported on this form were made 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 tests are correct to the best of my knowledge and belief. <br /> NAME (print)- TES S WERE COMPLETED ON: <br /> ADDRESS. CERTIFICATION NUMBER: PHON NUMBERIoptional): <br /> " <br /> rcu f -S. ¢ u. �� /�3 ��/Pb5/6- //,/15 K5 35P3 7/5 m' - �� <br /> CST SIGNATURE- <br /> DISTRIBUTION: <br /> IGNATORE:DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) – OVER – <br />