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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 37969 <br /> HUMAN RELATIONS MADISON,WI 5707707 <br /> (H63.090) & Chapter 145.045) <br /> HLOCA�l SECTION: MUNICIPALITY: LOT NO. BLK. O: U BDIVISION NAMb NCP <br /> .Ckj � "/� ' ) <br /> COUNTY: WN R UYER'S NAME: l M iAIILING ADDRESS: <br /> o u s <br /> USE x DATES OBSERVATIONS MADE <br /> LXR <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> esidence /� �IVew ❑Replace I�r�► �_ ..r <br /> .L 1 5-- V3 <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOL DING TANK: RECOMMENDED SYSTEV:(optional <br /> CAS ❑U ❑S (�U��S ❑l ❑S CCU ❑S . A Ctl u ��..� �� <br /> If Percolation Tests are NOT required DESIGN RATE: [Floodplain, <br /> any portion of the tested area is in the <br /> under s.H63.09(5►(b),indicate: indicate Floodplain elevation: <br /> PROFILE DESCRIPTIOKLS <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 /> v <br /> B- (� 3 7'Z i Q e + i F ( G v <br /> B- Z 74.d to ( L�� 71 I <br /> r <br /> it . �c of <br /> B d "L Q 'O k 6 <br /> B- 97" ( C. A <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH <br /> P- <br /> P- <br /> Al. <br /> � c3 ( - <br /> P- 3 - 91 f — 4 2 <br /> P- _ '�/ _ ft <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. .3 <br /> SY TEM ELEVATION Yoo AV*-,-A �'`' _- <br /> 75v r <br /> (" <br /> C�.vw) AVC-ck �0 �' �.17 4so <br /> 16 <br /> r <br /> 10 <br /> 516N <br /> C 7o , tj <br /> r , <br /> 130 <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(print): TESTS WERE COMPLETED ON: <br /> ADDRESS: CERTIFICATION NUMBER: IPHONE NUMBER(optionel): <br /> ' CST S I Gr// <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> D I LH R-SBD-6395 (R.02/82) OVER — <br />