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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> P.O. BOX 7969 <br /> LABOR AND <br /> HUMAN RELATIONS PERCOLATION TESTS `115) MADISON,WI 53707 <br /> (I LHR 83.090) & Chapter 145) <br /> N�TIO1/4 1:G ,/ SECTIO�� N/R Elor) TOWNSHIP/MUNICIPALITY: OT NO.:BLK.�NO.: SUBDtIVISION NAME: <br /> COUNTY: f�—�^ % /s''11 MAILING A4DR%SS �t 7'T <br /> LOEL BRAND=M � (551 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER I ALD E S C R I PT IO N: El New 'RlReplace PROFILE �� A I TESTS: <br /> Residence �� J`Y I g �� <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND, IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:l optional) <br /> ❑S U 0SNU DS Et DS �U S ❑U a <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: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL 7DEPTHTO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATIONERVED HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> D— �B/Afs �-i11BNCS 10r-cn4dmath <br /> rB- 2 7 3 S o-(�B1 I+�s (� `b 8�1(6- 11' s ' G ucs Li R_ rite <br /> p-(obrw�s b . j4Bsj� URc M1 <br /> B-3 I 6 ' I <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> 1TES7 DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI D2 PERI 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 <br /> r r <br /> F12c t x-'7973 <br /> l 1b , Balbt�tofS1D1PG <br /> 0 � � D, TN <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 COMPLETED ON'. <br /> (CORP _ <br /> ADDRESSCETICA :NUMgB <br /> ERPHONE NUMBERJr(optional): <br /> 5l 10 CST SITURE <br /> i <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br /> Y <br />