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DEPARTMENT OF - REPORT ON SOIL, BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> P.O. BOX 7969 <br /> LABOR AND <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 <br /> (1 LHR 83.0911) & Chapter 145) <br /> LOCPLIATION 4 S'Cgr /ir N/RQ(or)W TOWNS�CV/'MF1A tfiY: LUTA* I A.NO.: SU6AIX NAME: <br /> C UNTY:+N) OWNS 'S BU ER'S N ME: MAILING ADDRESS: /v N� <br /> cf�A IP G ar �N/ F i- ier wl . <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IALDESCRIPTION: � IPRQFILE DEQ l IF:: DNS: PER ATION TESTS: <br /> esidence s ❑New Replace [// 3-8r <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ®S ❑U XS ❑U 0 ❑U ❑S CRU El NU v <br /> If Percolation Tests are NOT required DESIGN RATE: If 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 TOT+1NELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B / / S /0 <br /> B- c)- 3 � �' '' 3 �- r'F a�.. R e� f /vro " 7Q C S- <br /> 13- <br /> B- / 3 P v R V?n /o� " c s <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 AFTERSINELILING INTERVAL-MIN. PERIOD PERIOD P PERINCH <br /> P- <br /> P- <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 plat plan. Show the surface elevation at all borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION <br /> XP Q <br /> d <br /> 3 <br /> Top Jeb,� N <br /> qr4 pwCLl ) S <br /> Pill � 30 76 '77 <br /> I, the undersigned, hereby car �fy 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 /> N print) ITESTS WERE COMPLETED ON: <br /> s �� � — 3 - Yr <br /> RESS: CERTIFICATION NUMBER: PHONE NUMB ER(optional): <br /> r- 3 mss" -Yi <br /> CS AT RE: <br /> Y` <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DI LH R-SBD-6395 (R. 10/83) —OVER — <br />