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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 7969 <br /> HUMAN REiATIONS MADISON,W1537073707 <br /> (1-163.090) & Chapter 145.045) <br /> LOCATIONSECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> '/S�'/ /.3 /T�LN/R ! Ec 1W ,j! �s5 j <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> /Jl o"err '/L C 4 . S r' c'�/� /LfGO L` S-7 <br /> USE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: ,--,/ DATES OBSERVATIONS MADE <br /> Residence � � `6ll ❑Re lace PROFI E DE RIFIT IONS: R ATION TESTS' <br /> \New p <br /> .'S-7"3- <br /> RATING: S=Site suitable for system L=Site unsuitable for system <br /> CONVENTIONAL: MOUND IN-GROUND-PRESSURE: S STEM-IN-FILLHOLOING TANK:RECOMMENDED SYSTEM:loptionall <br /> ❑s ❑u ❑s ❑u ❑s ❑u ❑s nu ❑s ❑u P , , <br /> It Percolation Tests are NOT required DESIGN RATE: <br /> under s.H63.09(5)(h),indicate: I If any portion of the tested area is in the <br /> /` �_ Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AIDEPTH <br /> NUMBER DEPTH IN. OBSERVED E .HIGHEST TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) <br /> B- r,�Otiil f 5 " 131. 7s L. � . 2. S. <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-MIRATE MINUTES <br /> N. PERI D1 PERI 02 P R PERINCH <br /> P 1 _ 0 3% 3' 3 3yi <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 <Q K` / <br /> C- <br /> in .rl = cc r F1cu1c SnE `�._-_-- loci / <br /> ! da r <br /> 24 ..p, <br /> Bt43sd � <br /> rC 579rS_1'( y "_7 <br /> Api x z50e, ' <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 rind: - TESTS WERE COMPLETED ON: <br /> ✓1 -. 3— f, _ <br /> AD DR ESS: ' a CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> !� 1'� + >z c / Z ? f� /Y�t C✓ _ S� �d �Lv �L C� 3�2Tt <br /> IF CST GN URE:z7 <br /> Z/'L//Z C <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. ` <br /> DILHR-SBD 6395 (R,02/82) --OVER — <br />