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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, - BOX G DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (H63.09(1) & Chapter 145.045) <br /> J;AT O'/NF1/ SECTION: `I /R`� <br /> (or) TO jSC IP/Mtlld46WC�Ll.T�/: LOT NO.:BLK.NOSUw SION NAME: <br /> c�OUNTV: +J— <br /> OWNER'S/BUYER'S NAME: n�AILING ADDRESS: NAI <br /> IS �r+ue rlf,11t te' .lc L IosC'ri ji-A lisbilzryU. x 'KI('11flcld ritj H '1 3 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMB.: COMMER IAL DESCRIPTION: S�II PRFL/j�/OLE DESCRIPTIONS: ER A lONTESTS: <br /> Residence XNew ❑Replace I 1 (.ice a� I • L^ <br /> RATING:S=Site suitable for system U=Site unsuitable for system / <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> XSEU XSE11 ©sou ❑S ®U ❑S ®U foN ✓ <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 TOTAL DEPTH 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 /> 13 Z �Ls 1pIV,,! 1 \• �� /n'r <br /> !r <br /> B 3 d� ���1 j9 I (c j< k c <br /> B- `I � 0 IL 6 1 lls S <br /> B- S ��) iQ, 0.1 > 2I ' Its r -5 �i',l C 'J T? c <br /> B_ <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 PER IOD2 PERIOD3 PERINCH <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 R <br /> Ell <br /> `C N <br /> i-A <br /> i <br /> Ct"'Y' t�2y' <br /> Stal< � <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 ): ,t— TESTS WERE CO PILE ON: <br /> 6 r c d it 1 n I <br /> ADDRESS: CERTIFIC TONU BER: HONE NUMBER(optional): <br /> 7- - ( � s s 4 3 is 66, /S <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />