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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, G DIVISION <br /> LABOR ANBOX 769 <br /> HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (H63.09(1) & Chapter 145.045) <br /> LOCATI N: SECTION: TOWNSHIP/MtI11te+PAC44�r' LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> S"= 1/ 33 /T39N/R ►I )W Lr►.�C rrfnd n!A n1A NA <br /> COUNTY: OWNER'S/ NAME: MAILING ADDRESS: <br /> )�T a 0C bs,j_,4 t�f 5 syS 3 <br /> USE DAT9S OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> Residence ❑New 3 I) Replace I � /•3 ff <br /> RATING:S=Site suitable for system U=Site unsuitable for system / <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: STEM-IN-FILL HOLDING TANK:RECOMMENDEDSYSTEM:(optional) <br /> zS ❑U NS ❑U LgS ❑U D �U <br /> C ❑S �U F il'iv, <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: fl <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IIN. ELEVATION OBSERVED EST.HIG <br /> H <br /> EST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- <br /> B- <br /> B- 72 2 © lV[arriE ' °72 1 / 9 F 3 <br /> S Bim, SC d•, , S <br /> B_ 3 75 9 4/'' IJOA)4 > "79 I 'L z" 'e:5 . fs, r <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 AFTER SWELLING INTERVAL-MIN. . PERIOD I PERIOD 2 PER10D PER INCH <br /> ! r 3� � .s. <br /> P- 3 <br /> P- to3 a a <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 `?O /o° <br /> 1 ( 1 <br /> l <br /> f Pea <br /> L. <br /> -T t t a� a $N _ E /0i xr- Tis <br /> �- <br /> - TO4P U kis <br /> 133 <br /> ffi <br /> • VR N <br /> 1 <br /> 15A <br /> C�s <br /> YNi&Al <br /> t <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): n TESTS WERE COMPLETED ON: <br /> L'1>11/97?fl ( sLffi?OEf�C're 6 -- /S�_- W�y <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 1?' 2 80k Flo 514t lvt C_57_04'21 T11 <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> nn uo COM-9109 to r»r¢o1 <br />