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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, � DIVISION <br /> LABOR RE PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,WI 537073707 <br /> (H63.090) & Chapter 145.045) A <br /> LOCATION:e�, SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> Al <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> h ^ �� <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: DESCRIPTIONS: PER OLATION TESTS: <br /> Residence ❑Replace [PROFILE <br /> "7 <br /> RATING:S=Site suitable for system U=Site unsuitable for system // Q <br /> rCONjVjENTT[1_0!NAL: IN-GROUND-PRESSURE: SYSTEM-IN-FILL IO DING TANK:RECOMMENDED SYSTEM:(optional) <br /> U ®S ❑U ❑$ 2U ❑S ®U <br /> If Percolation Tests are NOT required DESIGN RATE: If any <br /> portion of the tested area is in the <br /> under s.H63.09(5)(b),in 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.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B-a- �o q i y > o s `W <br /> B-3 8 Q 9 7: a "( 7 Q If' CS <br /> B- c 17 � � ) <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODA PE IO 2 PERIOD 3 PER INCH <br /> P- f <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 96= � q <br /> /No a L f/J <br /> Q � <br /> , <br /> I 4 jS <br /> I ea <br /> 114 <br /> 10 <br /> 1tN <br /> 10 <br /> l <br /> las <br /> r <br /> t <br /> j E i#r � 01I <br /> 4 <br /> i t <br /> I <br /> 17-1rr <br /> b t S c <br /> { �t <br /> L�es� <br /> I,the undersigned, hereby car that the soil tests reported on this form ere made by mein accord with the procedures and methods specified in the Wiscor i <br /> Administrative Code,and that the data r ded and the location of the tests are correct to the best of my knowledge and belief. <br /> NA (pri t): TESTS WERECOMPLETED ON: <br /> C ` / _ 6J <br /> ADDRESS: r �n CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> D S f Is'- ;Ze-r-F6 if <br /> CS IGNA URE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />