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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY,. DIVISION <br /> LABOR AND P.O. BOX <br /> 969 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 537073707 <br /> (ILHR 83.090) & Chapter 145) / .07 ( <br /> LOCAL `r'� hC� /T N/R1��IorIW T(,"tf J10�. p- O:%O :BUK_I1 .: SUBDIVISION N ME: <br /> COUNTY: I� d MAILING ADDRESS: !V 41 N <br /> Burs ttfi 160r0w as S d LAJ Kf'Q1l Gvi V FYtj <br /> USE DATES OBSERVATIONS M E <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: A ESTS: <br /> esitlence ❑New ,RePlace 17 - / 7- cyU �,� `Q-� � <br /> RATING:S=Site suitable for system U=Site unsuitable for system / L L Z <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYS M:(o tion II <br /> ❑S U 1XS ❑ $ U ❑S U ®S U dtc ¢ce t <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: I Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL PTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED HEST TO BEDROCK IF OBSE V D ISEE ABBRV.ON BACK.I <br /> o- - r s / <br /> B- Str �� �OrvQ 8, tr W N2� 7 �Pcn-� 0 J6 - gs RC wi r 7` `*?Cw0 <br /> f _ .wo <br /> B- 3a S GC w . Qca p <br /> 2 /� 7 0 - c - b K - <br /> B- .J 7 �r / t ' / f! c � O eZ <br /> f 0 -8 BC r a - ay w L w a <br /> v <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> lTEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> i NUMBER INCHES AFTERSWELLING INTERVAL-MIN. _PERI0Q1 PERI002 P PERINCH <br /> P- / ! P%D / y IML <br /> P- N oily <br /> P <br /> P- <br /> P- <br /> as `- <br /> PLOT PLAN: Shoff acations o-f percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- <br /> zontal and vertij efer a- is 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 /> ,E�TEM ELEVATION R 7. S' _ _ 80 tic f,Ir s <br /> it _ R�/'�- • <br /> w 1Bo�r _ d: <br /> i <br /> flu <br /> ref <br /> T, <br /> <nc� ! "^ tc � NnI ( rN FckCa 11037 to 10 <br /> r <br /> I, 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 , TESTS WERE COMPLETED ON: <br /> I1Q0 pt`1C I TCp•` trl -{ — ` t3 <br /> ADDRESS: CERTIFICATION NUMBERPHONE NUMBERIoptionall: <br /> q1 7.s fro yes <br /> C!�J,SIGNATURE� a <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBDZ395 (R. 10/83) - OVER - <br />