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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> NDUSTRY, / DIVISION <br /> -ABOR AND RELATIONS PERCOLATION TESTS (115) <br /> P.O. BOX 969 <br /> (H63.0911) & Chester 145.045► MADISON,WI 53707 <br /> v - <br /> LOCATION: F SECTION: TOWNSHIP/ OT O.:BLK.NO.: SUBDI 1 66 <br /> AM ! u <br /> SGQ 4 36 /T y oN/R �So(or)W 7 4 C .r�� / �i� s_�' �7 <br /> (�UNTY: OWNER'S &LPAra ME: MAILING ADDRESS: Q <br /> 1SE DATES 013SERVATIOWMADE <br /> NO.BEDR% MS.: COMMERCIAL DESCRIPTION: �-y PR A S S: <br /> Residence L79New ❑Replace I Q� (r3. <br /> IATING: S=Site suitable for system ISite unsuitable for system v_ <br /> ONV NTIONAL MOUND: IN-GROUND�'RESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYST6M:1tptional) <br /> XS ❑U WS ❑U , �SDU I OSXV I [JS ®U Co g <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> .ender s.H63.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> 30RING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> gUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) / <br /> B- �� q IV e w f -��'p 5"13K r �, S " rrv► � 1 S <br /> - 116VI Sy s'e �f s <br /> IS "on 1, ' 17 4 S S-F '� <br /> B-q W 0 q I y 71r S n�►� 1 Sle <br /> B <br /> Y •1 �1 <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> VUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERI D 2 P PER INCH <br /> P_ 3 - . ' �^ o / r3 i <br /> P ;L N c 3 <br /> P- <br /> P- <br /> OT 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 /> ntal and vertical elevation reference points and show their location on the plot plan. Show the surface elevatio at all borings and the direction and percent <br /> land slope. <br /> ►YSTEM ELEVATION pat�s'Q <br /> gj ALi <br /> tN <br /> Is- <br /> toe <br /> Q►� q � n.__L_ <br /> 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 /> dministrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> AME (print): TESTS WERE COMPLETED ON: <br /> Ea cat C,I c 11 � � '► .n S _ Is- y F � <br /> DDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> r7 <br /> C GN URE: <br /> ISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> ILHR-SBD-6395 (R.02/82) -- OVER — <br />