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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR ANDP.O. BOX 7969 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 <br /> (H63.090) & Chapter 145.045) <br /> 146 <br /> LOCATIO ECTION: OWNSHIP UNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> t/ / /T �I/R E ( r _0T <br /> N Y: OWNER'S BUYER'S NAME: MAILING ADDRESS: J/ <br /> USE DATES OBSERVATIONS MADE `- O <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILEDESCRIPTIONS: PERCOLATION TESTS: <br /> Residence DlReplace <br /> �/' —/— �—/_ 'C <br /> '7 <br /> RATING:S=Site suitable for system U=Site unsuitable for system T�' �'�/'�e / /' B• b a G -3a ,T z0/ �5 <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-F I LLHOLDING TANK MENDED SYSTEM:(optional)S ❑U S ❑U SEA ❑S RJU ❑S 2U : RECOM4/0 <br /> o a b <br /> an <br /> If uired D : <br /> q y portion of the tested area is in the <br /> under s.H63.09(5)(b),lndicate: �j Floodplain,indicate Floodplain elevation: <br /> If Percolation Tests are NOT re DESIGN RATE <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH TO R UNDWATER-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- /bo--w otic O 0-6/3//5 G -6U / c, Go X72 c <br /> B- 72 o v. J1%- e o dog <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 I WQWN, AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD 2 -_-�PPERINCH <br /> P- r Oyu e <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 /> 401411 0 "epc' <br /> M U � <br /> �N <br /> Da/ . <br /> h <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. 6 .. a <br /> NAME (print): <br /> 0'W'e°" I h/ <br /> � TESTS WERE COMPLETED ON: <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> `f Gr .k)i —7� �� 7 - <br /> - CST SIGNATU E: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DI LHR-SBD-6395 (R.02/82) -OVER - <br />