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DEPARTMENT O.FREPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> DIVISION <br /> INDUSTRY, <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS (H63.09(1) &Chapter 145.045) <br /> LOCATION:,`,iC',! SECTIO�T,�o N/R / lor)w TOWNSHI/ Y: OT_NO.:BLK.NO.: SUBDIVISION NAME: <br /> CIIJUN-rY: J T/J O NER'S BUYER'S NAME: { MAILING%ADDRESS: JPJ N/ <br /> USE DATES OBSERVATIONS MADE <br /> ��ff tPfi <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: per- PROFILE DESCRIPTIONS: LATION TESTS: <br /> LpResitlence 1 ❑New eplace I r _\ () `8 1/ �_3 0- 9 y <br /> RATING:S=Site suitable for system U=Site unsuitable for system J cT <br /> ONVENTIONAL: MOUND: 1"-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> os ❑u �s ❑u �s ❑u ❑s ©u ❑s ®u 6 w� <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: A/ <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- � > so 61" <br /> 9 [s `' F � S <br /> B3 8 � X19 6"B� Lr kyr, S <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. PERIODL PERIOD 2 PERIOD PERINCH <br /> 3 3 s 9 <br /> P- <br /> P- d iO s <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 horn <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 ELEVATIONco L <br /> ab P-3, <br /> TN <br /> �6 s TSP �d_o <br /> F-7- <br /> 1, <br /> T,7' <br /> I, the undersigned, hereby certify that the sail 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 /> NA (pri tl' TESTS WERE COMPLETED ON: <br /> `� <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> Lf <br /> CS NAT R � <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />