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DEPARTMENTOFREPORT ON SOS BORINGS AND ��r�, �� N <br /> INDUSTRY, DIVISION <br /> , <br /> LABOR AND PERCOLAT TESTS (115) MADISON,WI 57969 <br /> HUMAN RELATIONS <br /> (H63.0911)a 145.045) <br /> LOCATIO L SECTION; TOWNSHIP/ Y: OT O.:BLK.NO.: SUBDI VISION NAME: <br /> '/4 �/ �l t /T� N/R i E(or) til xAAA <br /> C NTY: OWNER'S BUY NAME: p- <br /> IF <br /> USEDATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMM R AL DESCRIPTIO w,' <br /> PROFILE UESCRIPT <br /> ❑Residence ❑f�, ❑Replace I fI'.. � /_ RCULATI ON T!7] <br /> RATING:S=Site suitable <br /> �for system U-Site unsuitable for system d I O <br /> COa STI❑U Ml_1S ❑U IN-G❑S ❑U . EI �.. L SG❑U .REC^MEN[)ED SY$T�yloj tiEonal) <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s.H63.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DORN"ONS <br /> BORING TOTAL P H R UN DWATER-1 C OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OgSERV D IF OBSERVED (SEE ABBRV.ON BACK.) / <br /> B- •S/ 0 <br /> B- l<< Q, r J u �r sa s4. <br /> B- O #Flu r <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 AFTERS WELLI INTERVAL-MIN. PERIOD 1 PERIOD 2 PER INCH <br /> P- <br /> p <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 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 <br /> E1 i V <br /> T I � <br /> aY <br /> {4 <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 /> NAME7prmt : r TESTS WERE QMPLETED ON: <br /> � -C Fr r( C ! (f ( — �?l (/ <br /> AD-DRESS: _ CERTIFICA110 NUMBER: IPHONE NUMBER(optional): <br /> DISTRIBUTION: Original and one copy In Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) OVER - <br />