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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> HUMAN REOLATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (I LHR 83.0911)&Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISI NNAME: <br /> 14 l _/T liN/R15E (o W SWl 3 NA C - <br /> COUNTY: MAILING ADDRESS: PHONt4; <br /> .BQKWF-TFD O U E t 05C,E0L_A , jjj 5goLfo 7-55-3622- <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: TESTS: <br /> Residence � « ®New ❑Replace 'I <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUNDPRESSURE: SYSTEM4 N-F I L LIHOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ®S ❑U ®S ❑U [ IS ❑U I ❑S ®U I ❑S ®U �I)AiAIKII <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> tl It any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DF_P(H IN. ELEVATION OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- k 7M 019.0 NONE >?2 0 -581rnin, 5-`12bWM5 <br /> B- 2 '72 -4 NONE x`72 o-4BkM 4- '12 Darns <br /> B- 3 '72 91.1 oNE 0-581rns 5- "17-5001S <br /> B- `1 'W 90)k_ >$o 0 5 Blues S-!bo BUMS <br /> B- 5 '7 �.2 0 ti x'72 o-4 ms -77-Nm <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I P RI D2 __P PERINCH <br /> p- I 3 No 5 7/1 3 <br /> P- 2 24 f3-,b <br /> P- 22)2. 7/8 3 <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. q4 4 <br /> { { I <br /> I I <br /> _.— K <br /> I <br /> a N <br /> - —� <br /> a <br /> T-1121 <br /> 41 <br /> ii , ...._.-. <br /> I 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 /> NAME (print): TESTS WERE COMPLETED ON: <br /> Xj CH 0D OPKI43 _ //-R - 9 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional):t: S F_? Wl 5` ( W <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SBDE395 (R. 10/83) —OVER — <br />