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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON769 <br /> WI 537077 <br /> HUMAN RELATIONS <br /> (1163.0911) tk Chapter 145.045) <br /> LOCATIONS SECTION: TOWNSHIP/MUNICIPA ITV: LOTNO.:BLK.NO.: SUBDIVt'SION NAME: <br /> Sw " 4 i /TyoN/R/� p(pr)W C) / ' o a %v/� <br /> Cgj)NTV: OWNER'S BUVER'S NAME: MAILING ADDRESS: <br /> t5"vrn �s � „ s� �/ <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS,: COMMER IAL DESCRIPTION: rte. PROFILED : E <br /> RIPTIONSR ATION TESTS: <br /> Residence `.1 45UVew ❑Replace I � / �`; 3,� a <br /> RATING:S=Site suitable for system U=Site unsuitable for system 7 a <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDI NG TANK: RECOMMENDED SYSTEM:(optional) <br /> M$ ❑II 1x$ ❑I) QK ❑$ U EIS 2U1 CoA) v. <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ,r <br /> under s.H63.09(5)(b),indicate: I I Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALD PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- *1 /0 to N ID Iv y 'B., tr 6 S ” <br /> e- C'71F I f > � V`'BgI( s l6 IF of � S <br /> B-3 271 y'6•1 4s 6 8 " it ti, <br /> B-1 7 to to > 7,4- 4 .r (P Y rf if, t . t l <br /> B ,V 7.)- 9 r � '� d/ 'Win4s- 6f '' If IN <br /> 4s- <br /> B- L, 7� 9• If 7 y` 194 BS (o I rr , I It I t <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PER D1 PERIOD PERIOD PERINCH <br /> t3 <br /> P- Q - a o S / % 3/ 3 <br /> P- IV 110 R // <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 O <br /> of land slope. <br /> SYSTEM ELEVATION 17 h. 5- 'j ° <br /> s�F (� f 9mt <br /> V b4tic'1it� VIC <br /> j <br /> A/OrrL % IU VftSctY _ r� 0 © <br /> o4r/U IN <br /> T. <br /> i <br /> t e2 S" <br /> (Ce e i t'r " F� <br /> I,the undersigned, hereby certify that the soil tests reported on this form were mad�Ey me in actor wit 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 /> NAM pri qt): TESTS WERE COMPLETED ON: <br /> od��� Ca K n � 3 � a9 -e if <br /> ADDRESS: CERTIFICATION NUMBER: IPHONE NUMBER(optional): <br /> 3 ?'<1- /s <br /> N TUR : <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> D I LH R-SBD-6395 (R.02/82) —OVER — <br />