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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, REPORT <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (H63.09(1) & Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/ FG+PAt14FY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> Ncv 1/.s -,1/a 16 /T.?q N/Ri,, a(.►W i�us"e_ <br /> COUNTY: OWNER'Sfab1*E I4-&NAME: MAILING ADDRESS: <br /> >3aeff Lc'.�o /t1e r2 Sfigc� %�� (fox yy,�,? �.,One2 ss<P� i <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> Residence ❑New ®Replace <br /> Wig I .S--Z Z—B y .S=z Z—� <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ©s ❑u as ❑u os ❑u ❑s au ❑s au J6s�� � �t��. <br /> If Percolation Tests are NOT required DESIGN RATE: [Floodplain, <br /> f any portion of the tested area is in the <br /> under s.H63.09(51(b),indicate: A�� indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH 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- <br /> B- <br /> B- <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 1 PERIOD2 PERIOD PER INCH <br /> P- /8 rv`&Ajc / ?% / iL / iZ 1 <br /> P_ G P' oA•c / Z%y <br /> P- MOA-c <br /> P- <br /> P- <br /> P- <br /> 'LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- <br /> ontal 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 /> A land slope. <br /> SYSTEM ELEVATION S" <br /> 3 <br /> F <br /> _ <br /> 51;J"Q,E <br /> i k <br /> I <br /> s <br /> E <br /> Y / <br /> 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 /> Iministrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> kME(print): TESTS WERE COMPLETED ON: <br /> )DRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 333, ss— <br /> CST SIGN A E: <br /> ,TRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> ,,,-, — n /o 1 —rl\/FR — <br />