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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, � DIVISION <br /> HLABOR UMAN AND <br /> DLATIONS PERCOLATION TESTS (115) P.O. BOX 7969 <br /> / MADISON,WI 53707 <br /> (H63.09(1) & Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/ LI Y: LOT NO.:BLK.NO.: SUBDIVI ION NAME: <br /> '/a a a`i /Ty0N/R/SQ(orlW T4cA--sc, / t,'� �(Ji4 - i c� <br /> COUNTY: OWNER'S/BtPe IE: MAILING ADDRESS: Ur/ <br /> I�Sarne Dr rq 44wre f�t'ar� <br /> USE DATES OBSERVATIONS MADE <br /> �NO�BE5)RMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PER OLATION TESTS: <br /> Residence New ❑Replace l cam , 7._�� <br /> RATING:S=Site suitable for system U=Site unsuitable for system l <br /> MMMSElU <br /> L: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ®S ❑� ®S ❑U ❑S ❑S ®U ® ter C� <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),indicate: 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.pHI1G�HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK..)) <br /> /y to <br /> '4s /ef "fir �`� M <br /> 19r,� 6. dry S <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 1 PERIOD2 PERIOD PER INCH <br /> P- <br /> P- 0 Q C S 3719 <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 pltn. Show the surface elevation at all borings and the direction and percent <br /> of land slope. (^ FJ <br /> SYSTEM ELEVAA q _ 43 l a ` rc tr f'I .W\ 1&4 <br /> `3 <br /> r rr c O <br /> 43 <br /> TN <br /> 4 ) <br /> 4 It <br /> I,the unde signed, hereby c rti y t at 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(prii tl: TESTS WERE COMPLETED ON: <br /> c <br /> 6 rrrc � o & - `7- 93 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> c..0 j w r' w`✓,-S c �' af'y� f{ 3 <br /> CS N TURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />