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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AN f <br /> HUMAN RE LATIONS 1 PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN <br /> (H63.090) & Chapter 145.045) MADISON,WI 53707 <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> Gf /2 /40/a I /Ty0N/R lbE ( r) ��,<C ,vim �o�q tii� cs <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: �,{ j_PRT0FIL_ED_ESCR_1PTI0_NS: PER OLATIONTESTS: <br /> Residence to New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> LIE] <br /> NVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:REC7M�ENDED SYSTEM:(optional) <br /> s ❑u as ou os ou as ❑u as ❑u , u, <br /> If Percolation Tests are NOT required DESIGN RATE: I 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.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- <br /> B- <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 1 PERIOD 2 PERIOD 3 PER INCH <br /> P- <br /> P- <br /> .- — <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 Ci/3 LO d _A, <br /> 6M 7-r,.p px 14 t <br /> Biob i �ZI•-C�•� <br /> r, <br /> ' N <br /> I <br /> I,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 /> NAMEJ,kj�intl: _ TESTS WERE COMPLETED ON: <br /> 77 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> -5 Beg q 70 <br /> G i!� <br /> CST�URE. � <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. C <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />