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DEPARTMENT OF REPORT ON SOIL BORINGAND SAFETY & BUILDINGS <br /> INDUSTRY, PERCOLATION TESTS 115 DIVISION <br /> LABOR AND P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (ILHR.83.09(1)& Chapter 145) <br /> LOCATION: SrCTIOW-.-&rOWNSHIP/M04IG4A Y: LOT NO.: LK.NO.: SUBDIVISION NAME: <br /> �/4S-&/% / /R/N /11ele�'L/d! <br /> COUNTY: OWN E MAI LINOD SS:/ 14 IC .stt/tl 0.3 190A --20AL <br /> USE DATES OBSERVATIO MADE <br /> rryyff <br /> IND.B DRMS.: OMM R DESCRIPTION: <br /> yc�Residence jNew ❑Replace f ESTS: <br /> RATING:S-Site suitable for system U-Site unsuitable for system <br /> ONVEN I L: MOUND: IN_ -GROUND TEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ❑S ®U ®S ❑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 83.09(5)(b),indicate: ���� Floodplain,indicate Floodplain elevation: 41A <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL P H R UN DWATER-INCHES CHARACTER OF SOIL.WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERV D TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.1 <br /> B > ! s/ BA �„ ,✓ X, Mer <br /> 13- 3 9%'Z2/ /� / s �� B s: /sin e /✓ �f'./hd <br /> [B- <br /> B- <br /> B- <br /> PERCOLATION <br /> TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WArE—RLEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. —PFRIOD 1 PERIOD PER INCH <br /> P- <br /> P- G1 Alel41'c— <br /> P_ <br /> P_ <br /> PLOT <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 <br /> lacyc �;4 L1 o� Ec <br /> F l A2 <br /> I I <br /> ♦+ PJB ,�7s �F uq rc� <br /> i <br /> /W <br /> 1 <br /> - i <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 WERE OMP ETED ON: <br /> ADDRESS: CERTIFI ATI NUMBER: PHONE NUMBER(optional): <br /> CST SIGNA U <br /> DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) -OVER - <br />