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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR ANDP.O. BOX 76 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (ILHR B3.09(1) & Chapter 145) 6)1— 2 Z <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> I/ <br /> Z� /TyoN/RISE (pr W J c an< 2 Np CSM VOL- 10 <br /> COUNTY: MAILING ADDRESS: <br /> 'ho KE 2 2- UELEI ?PLL- V LLE d- 5.SIZ <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: P OFI— TIONS: A ON TESTS: <br /> ❑Residence 7 t— <br /> �— ❑New ❑Replace y GI h r,ra <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVEX NTIONAL: MOUND: IN-G�ND-P�URE: SYST� I❑�L ❑�G�� .RECOMMENDED 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 83.0915)(b),indicate: I r-- - Floodplain, indicate Floodplain elevation: N� <br /> PROFILE DESCRIPTIONS <br /> BORINGTOTAL DEPTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATIGN OBSERVED EST. HEST TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) <br /> B- l '?Z X12 <br /> B- <br /> B- <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 IN ER SWELLING INTERVAL-MIN. PERIOD PERIOD R ERINCH <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 AMY a6-Z <br /> 11=_ ho <br /> 3"l loo faP aF JAZ <br /> fjR t -4 07$31� <br /> /undersigned, <br /> LB�o� $V401I,t hereby certify that the soil tests reported on this form were made by me in accord with the procedures and metho s spetlified 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 WER COMPLETED ON: <br /> ILiE (Z uPKII�S � - 9'L <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 2'77(0o w� 3S 5�C1 3 93 b ►S? <br /> CST SIGNA U E: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395(R. 10/83) —OVER — <br />