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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND115 PERCOLATION TESTS ( P.O. BOX 7969 <br /> HUMAN RELATIONS \ ) MADISON,WI 537073707 <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SEC N: TOWNSHIPfMHN}6VPAtIiK; ILOT NO.:BLK NO.: SUBDI VfS10N NAME: <br /> y� ( / /N/ (p (tet//�5 �s; nNCU'ly SPC. ?8 <br /> CO TY: MAILING ADDRES <br /> USE PIATES OBSERVATIONS MADE <br /> P(Residence <br /> BEDRM3.: COMMER IAL DESCRIPTION: YS: PERCOLATION TESTS: <br /> yp Residence 'New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> O VTI❑� . MyjS EU ING S ❑UESSE: SY❑STS -INFILL ❑�OLDINGT ,K:R C,pMMENDED SYSTEM-(optional) <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 TOTAL <br /> DEPTH T R UN DWATER-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 Z& ,B/ <br /> B- q9 <br /> B_ <br /> B- <br /> PERCOLATION TESTS <br /> LTEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> i NUMBER INCH S- AFTERSWELLING INTERVAL-MIN. p RI 01 P RIOD2 PERI0o3 PERIN�H <br /> P — ry <br /> P- <br /> d <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 ':�7CaC �=�O '�� ��� �v/�er ��"✓. <br /> - <br /> t__� tN <br /> O <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 ( rind: TESTSS�ERE COMPLETED ON: <br /> _ 9 D <br /> A D <br /> l _ CE RTIFICA ION NUMBERIP"ONENNUMBERloptiona0: <br /> CST SIGNATURE <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SOD-6395 (R. 10/83) – OVER – <br />