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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, c DIVISION <br /> LABOR HUMAN AND <br /> DLATIONS PERCOLATION TESTS (115) P.O. <br /> WI 969 <br /> (H63.090) & Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/ LOT 0.:BLK. O.: SUBDIVISION NAME: <br /> ,�S E ?4 4 J /TM/R/yPor)W � c � ' /N �G'l� .;o L � � J c <br /> UNTY: jf O NER'S UYER'S V4W E: MAILING ADDRESS: n <br /> c3 G bl Yi S ¢ L 4 l <br /> USE DATES OBSERVATIONS MADE <br /> NO.BED MS.: I�'SJMS.: COMMERCIAL DESCRIPTION: �y' PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> esidence New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: IMOUND: PRE SYTEM-IN-FILL HOLDING <br /> RE <br /> ❑S � /ENDED$ T�M:loptio <br /> I 17 <br /> cU �S ® �uS ®J ❑u � <br /> If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the <br /> under s.H63.09(5)(b),indicate: Floodplain, 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- d '� o � j 0 G S Ce' <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 /> NUM ER INCHES AFTER SWELLING INT L-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH <br /> P- <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 /> L L 0 ` <br /> IN <br /> TN <br /> n <br /> �; <br /> L� Ct &L _- -__. ----- --- <br /> . P, 'v 1 l <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 /> NA E (print): TESTS WERE COMPLETED ON: <br /> a �- @ kV, s (P / - I,__� <br /> ADDRESS: ` . CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> C!S 4NTURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />