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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, C DIVISION <br /> LABOR ANBOX 76 <br /> HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 5379079 53707 <br /> (H63.090)&Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/�X: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> 1/ 1/ a /Tvd N/RiyE .pr 1660-,-F 1f4 s - - <br /> COUNTY: OWNER'S 9W'ER'SPh4ME: MAILING ADDRESS: <br /> UDE to =s E L <br /> USE DATES OBSERVATIONS MADE <br /> 5C <br /> NO.BEDRMS: COMMER AL DESCRIPTION: PROFI D TIONS: /R+ ATION TESTS: <br /> �p Residence z A,y New ❑Replace I 9-�G a'S 7-p1i'8� <br /> RATING:S=Site suitable for system U=Site <br /> ll u''mu�itable for system /' 7' <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL HOLDING TANK: RECOMMENDED <br /> SYSTEM (optional) <br /> ®s ❑u ❑s ©u ®s ❑u ❑s ©u ❑s ®u <br /> It 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: /} R Floodplain,indicate Floodplain elevation: NA <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL <br /> DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPfH IN, ELEVATION OBSERVED EST.HIGH TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 0 99,E o R s <br /> B- S 93 9 .3 No >83 <br /> B- <br /> B- <br /> B- <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 1 PERIOD2 P R 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 /> , <br /> IN <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 COMPLETED ON: <br /> TAtAL ALmea, 9-c�4 '3S <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> Sf"21IN4S CIJIL <t O 172 fal'? Z- <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. /- r <br /> DILHR-SBD-6395 (R.02/82) —OVER — ?AGjr �2 0F <br />