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DEPARTMENT OF REPORT ON SOIL BORINGS AND DIVISION <br /> LABBUILDINGS <br /> OR BOX 69 <br /> INDUSTRY, Vv <br /> LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707 <br /> HUMAN RELATIONS <br /> (H63.09(1)& Chapter 145.045) <br /> LOCATION SECTION: TOWNSHI / OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> SE 14 1/ /T U N/R//� IF(gr)W o ti�r� WAL I IC* <br /> C UNTV: OW ER'SBoin:vrc: MAILINGADDSS: r/ <br /> r.t e .fit a F � � 9 u RE1�'S S7 r n FL=r Z J 7 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFI E DESCRIPTIONS: PE OLATION TESTS: <br /> (Residence Xew ❑Replace �� <br /> RATING:S=Site suitable for system U=Site unsuitable for system 7T <br /> CONVKRNTIO❑NAL: MOUND: IN-G> s ❑uRE: SVS[IS INFILL HOLDING TANK:RECOMMENDED SVSTEM:(optional) <br /> _ U S S ([RUOS (LA r o ry V <br /> If Percolation Tests are NOT required D <br /> ESIGNESIGN RATE: If any portion of the tested area is in the <br /> under s.H63.09(5)(b),indicate: IFloodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH 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" '7 ``,//y 1 l) l7 N `> '7 a.- 'rB Aj If. /J d rr L S_ /2 J`G to rM(F <br /> B- / / II t/ r, h 1' / U Ir / r n ®rr ,tz 4 3 ' <br /> B- : /00 /0 o n" s <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 PERIOD2 PERIOD PERINCH <br /> P- A / /( / 7/(p <br /> P- <br /> P- A! 0 to / 3 <br /> P- <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of percola on tests, soil borings and the dimensions of suitable soil areas. Indicate tale or distances. Describe what are the hori- <br /> zontal and vertical elevation reference ints nd show their location on the plot plan. Show the surface elevati at all borings and the direction and percent <br /> Sland slope. <br /> SYSTEM ELEVATIO � cl'f <br /> V �i <br /> ilk �'' jp-� ��� • <br /> *4��r <br /> rP r T __ N <br /> Q Kv\ o "Z3 w t t / % 6 <br /> I <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made y me in aced with tRE 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 /> NA (pri ' I TESTS WERE COMPLETED ON: <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> C IGN)TURE_ <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — ( <br />