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DEPARTMENT OF REPORT ON SOIL BORINGS AND r SAFETY & BUILDINGS <br /> INDUSTfiY, C 1 DIVISION <br /> LABOR AND PERCOLATION TESTS (115) J MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (H63.09(1) & Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/ NO.:BLK.'NQ.: SUBDIVISION NAME: <br /> r .;" . c /T ( N/R (or)W JJ ! /ii11I1�� YY�,11 N P <br /> CEsUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> rv� Tr 4/ v y v S 3 31-S-17 <br /> USE If DATES OBSERVATIONS MADE <br /> NO.B RMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS. PERCOLATION TESTS: <br /> I ISResidence I I LNNew ❑Replace Q7 _/�� f 3 _ r Q <br /> RATING:S=Site suitable for system U=Site unsuitable for system o ! 0 d o <br /> MCOiriMi4r,�GR�"fRESSURE- SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)❑U ❑S [XU ❑SCCU C0rvy <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 /> BORINGI 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 P A.) Zrk•e > 7Jx— E� RCS (co it <br /> B 3 <br /> Am v <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 t PERIOD2 PERIOD PER INCH <br /> P C, d t o a /� a /i <br /> P s— <br /> P 3 a s s <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 /> - <br /> IF <br /> , <br /> i <br /> Q <br /> .....__ , <br /> i II t <br /> l I <br /> i <br /> — I <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 /> Nq E(jt1: R TESTS WERE COMPLETED ON: <br /> � h� c <br /> ADDRESS: CERTIFICA ION NUMBER: PHONE NUMBER(optional): <br /> lv � � sTr csca � �/3'y � Y-27 17 <br /> �S��E �- y/ <br /> C5;F-qGN TUBE: <br /> r � <br /> Aqw— <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />