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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON INI 53707 <br /> 11 LHR 83.0911)& Chapter 145) <br /> LOCATION: SECTION: TOWNS HIP/MUNICIPAL ITY: NO.:BLK.NO.: SUBDIVISION NAME: <br /> E1/ f- �/ 3 /T41 N/RA E (or SW I55 OT A A <br /> COUNTY: MAILING ADDRESS: <br /> b <br /> USE DATES OBSERVATIONS MADE <br /> NO.BED RMS: COMMERCIAL DESCRIPTION: IPROFI LE TS: <br /> ❑Residence t./V1 �_ ❑New ❑Replace I 2 . Q _A� A)✓I <br /> RATING:S=Site suitable for system U=Site unsuitable for system l / l5 �Y�`! <br /> ONVENTIONAL: MOUND: IN-GROUND-PRFSSURE: S STEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> EIS ❑U EIS 1:1U ❑S ❑U OSOU ❑S ❑U PRiuv <br /> / <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)(1 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 ST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- I qo q�. l AME > 90 0 - 90 BAjrvu <br /> B- <br /> 13- <br /> 13- <br /> 13- <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 P RI D 2 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 plot plan. Show the surface elevation at all borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION 3i <br /> I <br /> i <br /> I <br /> __. _ <br /> I <br /> I <br /> I , <br /> ,301If <br /> N <br /> WTI <br /> _r <br /> i i I 1 C <br /> i 1 I <br /> I, the undersigned, hereby certify that the sail 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 /> 1 0 OPK1�s ____ IS - 1 -IM <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> (. 0 5 <br /> CSIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBDG395 (R, 10/83) —OVER — <br />