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DEPARTMEWT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, / DIVISION <br /> HLABOR UMAN NDATIONS PERCOLATION TESTS (115) P.O. BOX 7969 <br /> (H63.090) & Chapter 145.045) MADISON,WI 53707 <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> �/a�/� e� /T3" N/R Vor)W _A, L <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> �. 6lid <br /> USE DATES OBSERVAT115NS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIP iPROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> Residence New ❑Replace I �} / /V'P <br /> RATING:S=Site suitable for system U=Site unsuitable for system (/ <br /> CONVENTIONAL: MOUND: Nu IN-GROUND-PRESSURE: SYSTEM-1 2- LHXSG❑U TECOMMENDED <br /> /l r SYSTEM:r,,4&k <br /> SS UU SS SS ��J(U S • -fij• r--. <br /> If Percolation Tests are NOT required DESIGN RATE: 11, <br /> f any portion of the tested area is in the <br /> under s.H63.09(51(b1,indicate: loodplain, 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.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B14e /lie!vim 7 a C7 11� �,, P, <br /> B- /D�,G it/ 0IIVe/ /'V 4` R Lrs' <br /> B- 3.`� IV 0tV e, 7 ?d SL "Ts T iC 11' L L � <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD t PERIOD 2 PERIOD 3 PER INCH <br /> P- <br /> P- -A' O Cc <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 ELEVATION <br /> _RA,�e- L t4ke i�vt'v Sly IV <br /> j4,, V C...A ..©R✓ .. /..•, fq <br /> �L .► G: <br /> r 7 p <br /> `iy sous <br /> r u <br /> �v <br /> f <br /> CIO)- <br /> 1,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 /> -� 0 — 3 <br /> ADDRESS: CER IFICATION NUMBER: PHONE NUMBER(optional): <br /> L / a -12 7- <br /> C TSIGNATURE: <br /> s <br /> A <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />