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6/dt ys/ - / Pd d <br /> INDUSDEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> HUMAN RE PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (1463.090) &Chapter 145.045) <br /> LOCATION: SECTION: TOWN SHIP/MW4W0?*ttTV: OTNO.:BLK.NO.: S BDIVISION NAME: <br /> 4 /T foN/R/ (or)W q c -son 1/ 0 row S !t rrt <br /> C U .rF <br /> NTY: OWNE S BUVER'S NAME: MAIL NG ADDRESS: <br /> - r <br /> 91U If / s �° h f3 A t D r 0W Q AJ IV ti <br /> USE DATES OBSERVATIONS MADE <br /> NO.B-5 MS.: COMMERCIAL DESCRIPTION: PROF-LED ESCRI TIONS: E LATIONTESTS: <br /> Residence l UlNew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system V Q 0 <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDINGTANK:RECOMMENDEDSYS EM:Ioptional) <br /> 15 5 ❑U ❑S 2jU �S ❑U IS NU ❑S ®U Co ry v <br /> If Percolation Tests are NOT required DESIGN RAT If any portion of the tested area is in the <br /> under s.H63.09(5)(b),indicate: Floodplain, indicate Floodplain elevatio : <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D P HTO GR UNDWATE R-INCHES CHARACTER OF SOIL WITH THICKNESS, DOLOR, TEXTURE, AND DEPTH <br /> NUMBER DOT L ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV. N BACK.) <br /> B ► .� r 9 N� w'e � »- s "emk *7 Res � o „ r <br /> B- � ��- Q� �' t `] 0 Srrr3ti ( s 7 ` L, f �[dtf � e S'a I A <br /> B- 7a- 77 -)- 6'`'d, ts <br /> B- s %L <br /> B- 7a— str Cr 2 �r <br /> At U tf C C- .C((,UECOLATIONTESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIO!DI PERIOD R PERINCH <br /> P_ a <br /> s-/ -3 3/ 7 3 <br /> P- :l 1 0 3 Vit 3 Ift 3 7 3 <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 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 q <br /> D1r` <br /> oIfi Wt l <br /> . _ 3'` 1.3 <br /> Nam <br /> 4C 71 3 p• I�� Rd _ . <br /> vv TN <br /> S' <br /> O <br /> I,the undersigned, hereby rtify that the soil tests reported on this form a 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 (prTESTS WERE COMPL F3. <br /> E ------, <br /> 0 Lrtt, ` y U (o ` J 3 ` <br /> ADDRESS: CERTIFICATION NU ER: PHONE UMBERIoptional): <br /> 'V- fr"a°6 c <br /> CSTSIGNAT RE: <br /> `� <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. �.f�'k l i b.v <br /> DILHR-SBD-6395 (R.02/82) —OVER — '-rE <br />