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DEPARTUF <br /> INDUSTRY, REPORT ON SOIL BORINGS AND SAFETY & BUILDING, <br /> INDUS <br /> LABOR AND PERCOLATION TESTS (115) DIVISION <br /> HUMAN RELATIONS P.O. BOX 7969 <br /> (H63.090) & Chapter 145.045) MADISON,WI 53707 <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> u1%^ �u'/a�vu>/ `1 /T3=/N/R 7 Elnr� ,',t e li„ <br /> CO NTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> USE .1 a fJ ''�-'t: <br /> �Iy,// NO.BEDRMS.: COMMERCIAL DESCRIPTION: DAT CO OBSERVATIONS MADE <br /> 2-Residence (PROFILED SCRIPTIONS: PER LATI NTESTS' <br /> ENew ❑Replace <br /> �hr � <br /> RATING: S=Site suitable for system U=Site unsuitable for system '-�-- <br /> CONYENTIO❑NAL: MOUND:[]UIN-G <br /> RE: SYSTEM-IN-FILL HOLDING . R ryp SYSTEM:(optional) <br /> ❑SROUN ❑UEIS <br /> If Percolation Tests are NOTS requir¢d DESIGN RATE: S ❑U EIS <br /> S ❑U <br /> under s.H63.09(511b1,indicate: I If any portion of the tested area is in the <br /> Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OgSERV ED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B / l j7( ��� ) �"7 G it <'� It <br /> B- <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLETEST TIME DROP IN ER EV <br /> WATLEL-INCHES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. RATE MINUTES <br /> PERIOD ) PE RIOD2 PERI D PER INCH <br /> P- <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 <br /> let f <br /> TN <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 COMPeL'ETED/�ON: <br /> ADDRESStY Y c—> .�C .Y K- ! CL.b <br /> It ' 1 I' ray, CERT( I ATIONNUvi604': PHONE NUMBER(option,I) <br /> CS IGNATURE: <br /> m ITI : �.. ^-J a^d one copy in 1 <br /> .... OP! n. <br /> - . _Deal Avrhority, °,opr.ry-O,. ar and Soil Tester 1< <br />