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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND P.O. BOX 7969 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADJSON,WI53707 <br /> (1-163.090) &Chapter 145.045) A. <br /> LOCATION:�- SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> a if /T oN/R/SO(or)W �. wh <br /> COUNTY: OWNER'S BUYER'S NAME: AILING ADDRESS: <br /> � <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: PROFI E D NS: PERCOLATION TESTS: <br /> ResidenceNew ❑Replace I '�7 <br /> RATING:S=Site suitable for system U=Site unsuitable for system / C •S O <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: STEM-IN-FI LLHOLDI NG TAN K: R ECOMMENDED SYSTEM:(optional) <br /> SIS ❑U ❑SKU ®S ❑U S❑S 2U ❑S ®U C o n> 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 TOTALPTH TO GR UNDWATER-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- / �Ci 7 /UC 1tit /f0 q`'BML Iesr S, SI It Q C S <br /> B-3 0 9 ;- 'I 7 lY o "B2 1$ ` k4s S8 Iflef C <br /> B- e 4 1 � ? Or06.1 4f` $y " C S <br /> PERCOLATION TESTS <br /> RNUMBER <br /> DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> INCHES AFTERSWELLING INTERVAL-MIN. P IOD P to P R PERINCH <br /> 3 5 A/- o / / �- 7/00 <br /> 3:2.- v O / / S/ /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. 4 ' <br /> SYSTEM ELEVATION 9 6 • S Fr r - ;LV7 ,t _s h0. <br /> F <br /> I � <br /> _ r <br /> r <br /> ! are Ct <br /> yy <br /> -J,- 4: c7t/0 r17 <br /> 5 V <br /> �du�es F <br /> I, the undersigned, hereby car hat the soil tests reported on this form ere made by me in accord with the procedures and methods specified in the Wiscor61 <br /> Administrative Code,and that the data r ded and the location of the tests are correct to the best of my knowledge and belief. <br /> NA (pri tl: ` TESTS WERE COMPLETED ON: <br /> P�U f'IC7 - - 8 _'� <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> CS IGNA URE: <br /> t <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />