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DEPARTMENT OF REPORT ON SOIL BORINGS AND n SAFETY & BUILDINGS <br /> INDUSTRY, G DIVISION <br /> LABOR HUMAN RELATIONS PERCOLATION TESTS (115) P.O. BOX 7969 <br /> 3707 <br /> MADISON,WI 53707 <br /> (H63.090) & Chapter 145.045) <br /> LOC(A�TION: SECTION:T u Q TOW�N`SrH'IP/A#WMtPR'CTT�S�: LOT <br /> NO.:BLK.Nf/0�.: SUBDIVISION NAME: <br /> �t► '/S / j /1 ' N/R151(or)W �/ c�c.�s Cti/\ /" ^ /,''A <br /> COUNTY: OW ER'S/8L1X�R�-�d�cfdlE: MAILING ADDRESS: / _ <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: ��^^ PROFILE DESCRIPTIONS:1PERCOLATION TESTS: <br /> Residence ew 1�Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system ++•�%� <br /> CONVENTIONAL: MOUND: �IN-�GROU -PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> S ❑� $ ❑� ❑S ❑S ❑S �u C' C fll V <br /> F <br /> ercolation Tests are NOT re uired DESIGN RATE:4 IIf any portion of the tested area is in the <br /> er s.H63.09(5)(b),indicate: IL 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- <br /> B- <br /> B- <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 PERIOD2 PERIOD PER INCH <br /> P- ll a? 3 <br /> P- A C) Fy '? y .? s 3 <br /> P_ �► / `3 3 S_ <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 _ _ n L _ta <br /> �i 41 n FT <br /> Sib <br /> 10it1 <br /> d • <br /> 44 <br /> jed, <br /> 0-3I,the uri�erlsigereby 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 /> Adm istrative ,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> NA (pr' W. S TESTS ERE COMPLETE QN: <br /> �l 'F 4` 1 C <br /> ADDRESS: ...ram CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 3 �fr� <br /> CS GN URE: � I <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />