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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND - P.O.PERCOLATION TESTS 1115) BOX 7969 <br /> HUMAN RELATIONS 1 / MADISON,WI 53707 <br /> (H63.09(1) & Chapter 145.045) dZ 3 a 7s- <br /> LOCATION. SECTION: TOWN Y: LOT NO.:BLK. O.: SUBDIVISION NAME: <br /> :5 JE 14 / /3 /TYoN/R/ Igr)W Ja (- <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> Residence 3 ❑New �eplace I ro-,Se - spy p+ �� <br /> RATING:S=Site suitable for system U=Site unsuitable for system 7 J 7 O O <br /> CONVENTIONAL: MOUND: IN-GROUNDAPRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM.(optional) <br /> DS ❑U DS ❑U ❑k S ❑U ❑S SU ❑S ®U C e �r� <br /> I If any portion of the tested area is in the <br /> under s.H63.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL PTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED I EST.HIGHEST ITO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- I Fro Joy jvatwe S ",an Ls / !y" <br /> O- V/1 , c� S <br /> B- 63 `r f s <br /> B-3 8�r 98 s " 7 o s '/3f [ V / 'r L s <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MN. PERIOD PERIOD2 PER INCH <br /> a- " 11P <br /> P. 3 u d v i sl �/ <br /> P 41d to <br /> P- <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the horn <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 ELE ATION <br /> 4'P a <br /> (to ' Ctw' t <br /> I I <br /> A3 <br /> /dna ��•tT6 (-e <br /> �4 ,{V Dw� 11Cell, TN <br /> j34S`"r � <br /> lrt'° or <br /> ®� <br /> .-e."ccr,iafi w ",z <br /> rveT� t <br /> I,the undersigned, hereby certify that the soil tests reported on this form w7ere by me in accord with the pro dures and methods specified in the Wisconsin <br /> Administrative Code,and that the data recorded and the location of the tests are o t to the best of my knowledg and belief. <br /> NA IpriryTESTS WERLI COMPLETED ON: <br /> A DRESS: ! CERTIFICA ION NUMBER: PHONE NUMBE 11(optional), <br /> h T rJ <br /> CST GN TURE: <br /> h <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> '1I LHR-SBD-6395 (R.02/82) —OVER — <br />