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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND P.O. BOX 76 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (H63.090) & Chapter 145.045) <br /> LOCATION SECTION:Tt'/y� p� TOWNSHIP/Mt9Mf@fPfd_-ITY: LOT NO.:BLK.,NIO.: SUBDI VISIO N NAME: / <br /> NL �/ /1 4/m/R/�(or)W JQ ( 1472- <br /> 4 �✓�C O cf Ce O/ <br /> C UNTV: tet- OWNER'S BUYER'S NA-MSE: MAILING AD9RESS: ,p <br /> 4rntll L-er 5�...r / 'bva O /!Er l.�t/J s�/Q y <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMMER IAL DESCRIPTION: �r PROFIL DES IPTIONS: PER ATIOfffyyy TESTS: <br /> Residence Z ❑New XReplace I t-/1��r((� S , ` / � <br /> V �r Q r 7// <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDI NG TANK: RECOMMENDED SYSTEM:(optional) <br /> $ ❑II [AS ❑U ®S ❑U ❑S ©U ❑S ®U Cd n/./ <br /> If Percolation Tests are NOT required DESIGN RATE: I <br /> If any y porton of the tested area is in the <br /> under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, OBSERVED EST.HIGHffS—T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- ) ? 7 N�KI� �� p.i tr n n / it .. Nom' J <br /> BCMv1r y -bS 8., d 6s - <br /> 2;1 w <br /> 11.t o,rt. 8�,,, r yS y B r✓ »tea 7' U <br /> _-- V7-7a) s' BN„a..Os / RcHN <br /> B-3 �0 QG ' ) 1 �� C-Z w8_L atae S y v nnr.v S n <br /> r y - U H C, <br /> B- <br /> El <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD? PERI D2 p R PER INCH <br /> P F i a / o a VP Y.N_ / <br /> P- 1 02 ,. <br /> P- iv v <br /> '(42 <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 /> P""�° <br /> SYSTEM ELEVATION <br /> ► / ,y/ a�Tlr <br /> �, � <4N <br /> ln� ' <br /> r <br /> t� _A14; 1- Jiu gess /Ddor'FT <br /> 4,aT LiIV 9- <br /> 4/`c4 <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 /> N E Ipri tl: TESTS WERE COMPLETE ON: <br /> ' s �6 <br /> Q t rf c Q ! n <br /> ADDRESS: CERTIFICAON NUM ER: PHONE NUMBER(optional): <br /> 67v r- w ir r el ff 1/07 17/S-06-11/s7 <br /> C IGN TUR;: - <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. LjG <br /> DILHR-SBD-6395 (R.02/82) --OVER - <br />