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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN'RELAT4ONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTIOTOWNSHY. OT NO.:BLK.NO ` SN N M E:...... 7L/� M'5SE ±$L/ 1/4 �T / / Eto / <br /> CO NTYMAILING ADDRESS: <br /> NO 625 irf <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMMERCIAL DESCRIPTION: TIO PERCOLATIONTES S: <br /> Residence _ New ❑Replace /, / /�/,yO !� <br /> RATING: S=Site suitable for system U=Site unsuitable for system L (`-/ / /�- <br /> ON ENTIONAL: MOUND: IN-GRWND. RESSURE: SYSTEM-IN-FILL OLDINGTANK: REC MMENDED SYSTEM:lopti nal) <br /> ys ❑u ws ❑u �s ❑u ❑s u ❑s , u <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.091511b1,indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHESTO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) <br /> 13- <br /> B- <br /> B- <br /> -B B 3 vy /la-?"_' > <br /> B ��` /�1cy�� > ��14�j 7's, ••ems ��;�y �., <br /> B 05 64 <br /> e- <br /> PERCOLATION TESTS <br /> 1TEST DEPTH I WATER IN HOLE TEST TIME DROP IN WATER I- V L-IN HES RATE MINUTES <br /> T <br /> NUMBER INCHESI AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI D2 PERIOD PERINCH <br /> • <- � / 4 <br /> P- _ <br /> P- `J <br /> P d — <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 ii the direction and P9�rceenyi <br /> of land slope. <br /> r <br /> 66- <br /> B/ <br /> w <br /> TN <br /> ;.cif%-ICY,u '&71v tri 2d' X kC / : A Azrnq <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 print : TESTS ERE COMPLETED ON. <br /> J lO <br /> ADDRESS: CERTIFICAT ON NUMBER: P NU <br /> ONE M Rlopti pal), <br /> e .3�er r ---�9 3 5 - 1 � <br /> CST/SI,GNATUR E: <br /> vv <br /> DISTRIBUTION: Original and one Copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) - OVER - <br />