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DEPARTMENT OF DEPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AIVD , ' PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HOMAN RELATIONS' / MADISON,WI 53707 <br /> (H63.09(1) & Chapter 145.045) <br /> LOCATIONS SECTION: TOWNSHIP/M-16 +64�R,4L-}•1 : LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> S G,.► '/a /a /T o N/R/�f (or)W �, •�cf 'A— /U� tr,4 <br /> C NTY: OWNER'S/BUYER'S NAME: jl� JMAILING A DRES <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> J � IL Mew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system / V <br /> r7ff7fqd <br /> L: MOUND: IN <br /> SYSTEM-IN-FILLHOLDING TANK: RECO �E�EqSYSTEM:(optio(optional) <br /> ❑S U EIS U ❑S [RU CAS ❑U <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 DESCRIPTIONS <br /> BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> / C <br /> B-d— L L 0 S c� S � �, S , t� <br /> B- �t- . <br /> B !V M <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 PERIOD 2 PERIOD 3 PER INCH <br /> P- <br /> P- <br /> P- - <br /> Pp <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 /> ' <br /> f <br /> Y <br /> i y <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 /> NAME(pr' t1: v1 TESTS WERE COMPLETED ON: <br /> Wo !\I R c-- .> f�- <br /> AD RESS: , CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> C IG AT RE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> D!LHR-SBD-6395 (R.02/82) -OVER - <br />