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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> P.O. BOX <br /> LABOR AND <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 537073707 <br /> (1 LHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: — TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> k'1/_ / f, E _ ��a� �,� /�,�� - .✓r: <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: ,E <br /> >11 e� ,-!'�1 !/ Y< '�nb.,� ��r ! �� .� /r�2n rll_- � 1� �in .•in ov`� // /f E-? <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRM5.: COMMERCIAL DESCRIPTION: IPPOFI� PTI <br /> SCRIONS: PER <br /> CO <br /> ATION TEST <br /> ®Residence New ❑Replace t <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDINGTANK:R ECOMM ENDED SYSTEM:(optional) <br /> NS ❑U C.S ❑U �S ❑U <br /> COS ,®V EIS SU a <br /> DESIGN RATE: <br /> If Percolation Tests are NOT required If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH TO GR UNDWATER-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- <br /> B- r e- a W,, / a-1 v- IY i le ,/ / G c' k ii_i f ti. �x- //e< �__ �� l r" 7 ej lt <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD P R PERINCH <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 y - <br /> ' Id 1 cXi' 1—i Efrex <br /> I I TN <br /> p <br /> YI <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 /> jr- <br /> r// CL _ - .-). _- r�Oh Zl fl.. Ile <br /> L' <br /> ADDRESS: y CERTIFIC ION NUMBER: COME NUMBER(optional). <br /> CST <br /> TSSIGNATURE: <br /> i <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> 'LHR-SBDE395 (R. 10/63) —OVER — <br />