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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> DIVISION <br /> INDUSTRY, <br /> LABOR AND P.O. BOX <br /> 969 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 537073707 <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION:- SEC ION: TOWNSHIP/ OT NO. BUC NO.: SUBDIVISION NAME: <br /> u/1/4it/r�/1/ <br /> COUNTY: MAILING ADDRESS: <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: AN TESTS: <br /> 10 Residence xNew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIO AL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OL ING TANK: RECO M ENDED SYSTEM:(o banal) <br /> ❑$ l�U ❑S SIU ❑S �U ❑S U �S ❑U /n <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: I I I Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTHTOGROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHE T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B <br /> B / 7`1 rr `7 / �Or/ /�rr N/ .e T a,1157" <br /> 97"? _1?prr <br /> N <br /> B- <br /> 13- <br /> B_ <br /> B' <br /> PERCOLATION TESTS <br /> L FST DEPTH I WATER IN HOLE TEST TIME DROP IN WATER LE—VEL-INCHES RAPER INCHES <br /> f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RI D1 P RI D P <br /> VP- <br /> P- <br /> P- <br /> p- <br /> P- <br /> p reo. <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. if xn* /1 <br /> SYSTEM ELEVATION <br /> . whe/Te <br /> I <br /> ) i ) <br /> t ?-i-- +--t---r--r--` <br /> I <br /> R <br /> - _ <br /> _ . _ <br /> fi--j <br /> i <br /> 1, 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) ITESTS WERE COMPLETED ON: <br /> ADDRESS: C TIFIC TION N MBER: PHONE NUMBER(optional): <br /> �'O. / /013 a/eLis/er /.c�I �z/�93 5 3 - <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. S89 - 20047 2 <br /> I DILHR-SBDb395(R, 10/83) - OVER - <br />