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DEPARTMENT OF REPORT .ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> P.O. BOX 7969 <br /> HUMAN RELATIONS - PERCOLATION TESTS (115) MADISON WI 53707 <br /> (1163.090)& Chapter 145.045) <br /> LOCATION: SECTION: // y� TOWNSHIP O.{T NO.:BLK.NO.: SUBDIVII�SION NAME: <br /> S-W Y, 1, o1 /TqJ/R/ylLrlor)W SC 0 a /Z2� /" 4 <br /> CQUNTY: OWNER'S/BUYER'S NAM( f `: � MAI LING ADDRESS: <br /> Yn <br /> USE DATES OBSERVATIONS MACE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> Residence ❑ <br /> New Replace 0 -- 7 7- P J- <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-G�RpOJUND-PRESSURE: SYSTEM-IN-FI LL HOLDING TTA7N�K:R ECOMMENDED SYSTEM:(optional) <br /> S ❑U S ❑U (,CJS ❑U ❑$ ©U E LlG1U C Uyl J <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: <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. H GHEST T" R <br /> O'7BEDROCK <br /> /IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 7 } / 0 S 7 7 / (06 <br /> B_ <br /> 13- <br /> PERCOLATIONTESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 P R 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 ELEVATIQN3- <br /> ' Q � r <br /> 16 <br /> /N Jj <br /> _ _ I <br /> t 3Yl� <br /> tH <br /> KJrfj-t K/bor r t, IJLt9—, _ tl <br /> B <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made b me in accord with the procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the data riierlird n t e-location o orrect to the best of my knowledge and belief. <br /> 111 C I-r� <br /> NAME (print : TESTS WERE COMPLETED ON: <br /> ADDRESS: CERTIFICA18 TION NUMBER: PHONE NUMBER(optional): <br /> �S� r 3 7 <br /> CC SIG ATURE: <br /> DISTRIBUTION: Original and one COPY to Local Authority,Property Owner and Soil Tester. <br /> DI LHR-SBD-6395 (R.02/82) —OVER — <br />