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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, 1 DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON BOX WI 7969 <br /> HUMAN RELATIONS <br /> (H63.09(1)& Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> �/ 1/4 19 /T4? N/R 14 (or)W Scott 22 CSM Vol. 5, Page 309 <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> Burnett Dick Newman 518n Greenwood Circle, Excelsior, Mrr55331 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> Residence NA Q New ❑Replace I April 25, 1984 NA <br /> 'his test. was done to detArmine the suitability for a nrivv <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> EIS ❑U ❑S ❑U ❑S ❑U [--Is ❑U ❑S ❑U Privy <br /> If Percolation Tests are NOT required DESIGN RATE: I 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 GROUNDWATER-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 /> B-1 62 NA None 48 4" Bl med s, 58" med s, with few coarse= faint <br /> Y-R mot at 48", few med faint Y-R mot to 62". <br /> B- <br /> B- <br /> B- <br /> B- <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 1 PERIOD PERIOD 3 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 NA /z <br /> 3 , <br /> 4 _ <br /> I TtNr <br /> i <br /> _. _. <br /> 3 lj <br /> € i <br /> € <br /> _ I — )_ <br /> t <br /> IWAJ <br /> � 4 � <br /> i <br /> I i S I f�irt2 <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 /> Thomas E. Swenson April 25, 1984 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> Route 1, Webster, WI 54893 55 2153 715-866-8445 <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />