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:PARTMENTOF REPUKI UN WIC DUFUUMUO M119-f DIVISION <br /> DUST MADISON,PERCOLATION TESTS (115) P.O. BOX 7909 <br />.BO D SON,WI 53707 <br />)MAN RELATIONS (ILHR 83.09(1)&Chapter 145) 61-2- L183--S1 S <br /> A N: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> 7l y, /T oN/RMio1 <br />)UNTY: MAIL( ADORED; <br /> E D DATES OBSERVATIONS MADE TS <br /> -71 <br /> NO.BEDRNS.: COMMER AL DES RIPTIO l I M A TES : <br /> Residence 2 r� WNew ❑Replace <br /> 4TING:S-Site suitable for system Ua Site unsuitable for system ! uu 1 <br /> STIEJ ❑� IN GNI S ❑� : S S EM NIU OEI S TANK:REC 0NV NDED�YST�M:loptional) <br /> RQUND <br /> f Percolation Tests are NOT required DESIGN RATE: I if any portion of the tested area is in the <br /> rider s. ILHR 83.09(5)(b),indicate: �-- Floodplain indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> ORING TOTAL O GR UNDWATEfl-INCHES CHARACTER OF SOIL WITH THICKNESS•COLOR,TEXTURE, AND DEPTH <br />(UMBER DEPTH IN, ELEVATION OBSE V E D HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> 3 qZ -91. 7- Oke >1Z- o—(.51R'V G-7z gtJms <br /> a2— 97- 19 A 0 >�2 o-(glalw &- 720t4?4S <br /> B-•3 �8 7 E ATL o- S5Inu5- '1z6�+rhs <br /> B '} 'lz Nonlav >�z- o- (p 131 Fro (9 17-BNMS <br /> e- <br /> PERCOLATION TESTS <br /> DEPTH WATER IN HOLE TEST TIME DR P 1 WAT R L V L-INCHES RAPEES <br /> TEST R INCH <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. �/ /` <br /> UU <br /> P_ 1 0 �. '/ 3 <br /> p_ t4D CI <br /> P. O <br /> P- <br /> P- <br /> P- <br />)LOT 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 />:ontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borin s and the direction and percent <br /> 3f land slope. DRIdE <br /> SYSTEM ELEVATION ��n•'7 °�G y `I G -__ _ -_ -- <br /> _ . ..- -- <br /> _ICA <br /> I''� <br /> -I - -- -- - _ — _- <br /> _ .. <br /> X( r - <br /> 0 <br /> 1,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 /> TESTS WERE COMPLETED ON: <br /> NAME(print <br /> lCNfiRD noPK]t4s I qZ <br /> ADDRESS: Q q� CERTIFICATION NUMBER: P ONE NUMBERIoptionall: <br /> 2'7 60 W1 �JE$STa<+e W/, 5�8 ✓ CST 33670 SIGNATURE: �- S <br /> DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> ,nnt41 —OVER <br /> — <br />