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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, 1 f DIVISION <br /> HUMAN RELATIONS PERCOLATION TESTS (115) r! � A MADISON WI 53707 <br /> (H63.09(1) & Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/�: LOT NO.:BLK.NO SUBDIVISION NAME: <br /> 3�� V&1/4 ' 3,/ /T 3� N/R/y f�)W �i s T i�1A�s�fi�i n,�� rti'4 tia .� <br /> COUNTY: O**C-&'S/BUYER'S NAME: MAILING ADDRESS: <br /> 46 z j7 A0) <br /> USE DATES OBSERVATIONS MADE <br /> iNO.BEDRMS. COMMERCIAL DESCRIPTION: r�• PROFILE DESCRIPTIONS PERCOLATION TESTS <br /> Residence a � !I IC1New ❑Replace 3 ,;,7 7 - k 3' <br /> RATING: S=Site suitable for system U=Site unsuitable for system _ <br /> r <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDIN( TANK: RECOMMENDED SYSTEM:(option.ill <br /> ® S ❑URS ❑U NS ❑� OS M ❑S CCU C e ,1,iv <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: N 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. HIGHFST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) <br /> B- 1 72 - 0 68 ff`' s , �' �'' <br /> T <br /> z <br /> B- T _ <br /> PERCOLATION TESTS <br /> EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PER PER INCH <br /> P_ / 36 N C3 3 <br /> P_ 9 <br /> P- 3 30 0 a 1 <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 /> pip, = /� . -om D L l ' ;z <br /> 2(- F�4 to AvA tN <br /> —J. <br /> sT- <br /> 0147 <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 reco nd the location of the tests are correct to the best of my knowledge and belief. <br /> NAME (print) TESTS WERE COMPLETED ON: <br /> ' Eli R G� GH►��/Jr� �-�3 - sy <br /> ADDRESS: CERTIFICATION NUMBER PHONE NUMBER(optional): <br /> �}- <br /> CST SIGNATURE: �( <br /> DISTRIBUTION: Original'and a copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) -OVER -- <br />