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DEPARiTME4VIP-OF . REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, � DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 7969 <br /> HUMAN RELATIONS <br /> LOCATION: SECTION: TOWNSHIP/ UNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> . 0/ '/ /T YCNIR/61(or)W S �. <br /> COUNTY: rNER'S/BUYER'S NAME: MAILING ADDRESSr/ <br /> USE ;r c L i(' DATES OBSERVATIONS MADE <br /> `— jNO.BEDRMS.: OMMER IAL SCR IO : I PROFILEDESCRIPTIONS:1PERCOLATION TESTS: <br /> Residence Nye New ❑Replace <br /> RATING: =Site suitable for s tem u' a U=Site unsble for system <br /> ET <br /> CONV TIONAL: MOUN : IN-GROU PRESSURE: SYST -IN-FILLHOLDING TA :RECOMMENDED SYSTEM:(optional) <br /> S ❑U S ❑U ❑U S ❑U I O S <br /> If Percolation Tests are NOT required DESIGN RATE:SYSTE EL If any portion of the lot is in the <br /> I i I <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 /> rs <br /> B-"S- �9 '7 a-- S" �'�� s 1" 4 S ,j` ( c .s v <br /> :;7 7,� �5- :0:1 <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 PERIOD 2 PER PER INCH <br /> P_ 1 3 to y.- <br /> P- 3 , <br /> P- <br /> P- <br /> P- <br /> PLAN VIEW: 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 slop. <br /> SYSTEM ELEVATION g 'r ,,C 4 <br /> e, <br /> to <br /> PT <br /> { <br /> I, the undersigned, hereby certify that the soil t s orted this form were made by me in accord with the procedures methods specified in the Wisconsin <br /> Admimistrative Code,and that the data recorded and t I on of the tests are correct to the best of my knowledge and belief. <br /> NA (pri tl: TESTS WERE COMPLETED ON: <br /> ADDRESS: CERT F.ICATION NUMBER: " ONE NUMBER optional) <br /> CS NA UREA _� r <br /> ASTRIBUTION: Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester. <br /> �\ IR-SBD-6395(N.03/81) <br />