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DEPARTMENT OF I REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR ANDPERCOLATION TESTS (1151 P.O.BOX 7969 <br /> HUMAN RELATIONS \ L MADISON,WI 53707 <br /> (H63.09(1)&Chapter 145.045 <br /> SECTION: TOWNSHIP/MUNICIPALITY: T NO. ILK NO: SUBDIVISION NAME: <br /> /T N/R l E(or) o <br /> COUNTY: O NERS R'S NAME: MA D , ..., <br /> s i <br /> FUSE MATES'OBSERVATIONS MADE <br /> NO.BEDRMS: COMMERCIALDESCRIPTION: Iqo . <br /> /V14Residence DaNew ❑Replace hO^Z�� ,..., A��N�J <br /> RATING:S-Site suitable fousr system U-Site unsuitable for system O^ O Y �Y <br /> �OJS ®as MOUND: <br /> l�l� IN-GROUND <br /> ❑J ®0 D$-I®UL DM$GTANK❑Y . YSTE optional <br /> If Percolation Tests are NOT required DESIGN RATE: If anyportion of the tested area is in the <br /> under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation:, AIA <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUP DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND.DEPTH <br /> NUMBER DE�PM IN, ELEVATION OBSERVED ' H TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK:) <br /> B <br /> _ / S- q f-/� <br /> B- � 4 9#' 7 A P/ L?✓�_ld`giYS(� ef ' �Fd"'ft <br /> B-3 31' If, 6r No IV (31Pr J*W S11- <br /> B- <br /> ILB- / M e5 f.'fl__&'y oda <br /> i B- d M o-(-TL ?-s &Y Ps'96 <br /> B. 3 M ® 'L zs Me P o9a <br /> PERCOLATION-TESTS <br /> T DEPTH WATER IN HOLE TEST TIME DROP IN WATL98LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I PFRIOD2 PERINCH <br /> P. <br /> P <br /> P. <br /> IP- <br /> P. <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable,soft 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 (wrings and the direction and percent <br /> of landslope. <br /> SYSTEM ELEVATION /Varum <br /> 44 <br /> - TN <br /> j ou a <br /> te . <br /> Ad/Vo ._ <br /> IFK FI - - - <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 /> dministrative 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 COMPLETED ON: - <br /> ADDRES : CERTIFICATION MBER: PHrl ONE NUMBER(optionel): <br /> " <br /> CS SIGNATURE: f , <br /> ISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> ILHR-SBD-6395 (R.02/82) —OVER— d <br />