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D INDUS-TR <br /> �N�`OF ' REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, G DIVISION <br /> HLABOR UMAN NDLATIONS PERCOLATION TESTS (115) MADISON WI BOX 7969 <br /> (H63.09(7) & Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/MWNIGIPAOTT : OT NO.:r BLK.NO.: SUBDIVISION NAME: <br /> Sw�/aN��/a io /T.�9N/R/-//(�v)W r,s ,� ,vim <br /> COUNTY: OWNER'S BkfYfR'S NAME: MAILING ADDRESS: <br /> � <br /> (-L jtry e.f�.. .4oL, / of . 4 F1 ,ve:�i. 9� yreps Sze,Z t^ 69' S/ <br /> M,�• �'S5�z.4 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS,: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> Residence c1 A64New ❑Replace <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILI-HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> CJS ❑U ®S ❑U ©S ❑U ❑S ®U I ❑S ©U 1 <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: AAL <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH 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- <br /> B Z 7 9�'; 78 y"c?i 5i rs - /A"�� vg- <br /> B- .3 <br /> P'-B- .3 hoz 9�,. 3' ? /oZ o- " disd "Sns v�-/oma.. an nWe(s. <br /> B !.O ��,. 3 ? GO d-3" i3/ Si Ts ? -sa" ✓3yrs Se — !.e" 3r mtd r. <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 PERIOD PERIOD PER INCH <br /> P- .30 dL)O N-c / Z / el ! <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 ELEVATIONCite <br /> S ' <br /> _"9 <br /> /e <br /> �AArc <br /> : <br /> tN <br /> ra' <br /> 7 <br /> E <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 /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> .1j. <br /> CST SIGN <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />