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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND G P.O. BOX 7969 <br /> PERCOLATION TESTS (11J) MADISON,WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION / SECTIO% to TOWNSHIP/Mlcll+K Atti•FY'. OT NO.:BLK NO.: SUBDIVISION NAME: <br /> CO TY: MAILING ADDRES5:141 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMMER IAL DES RIPTION: I '^ A STS: <br /> Residence �l -- ----_ ❑New �RePlace VJD�7//q ✓i2/ �/�L <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTElu . MZ S. ElY IN G0 S ❑� E: SVS❑TEM-I®ILL OO ING Tom. NK:RECS 2901 OMMENDED J-k -17 Ol-Voptionall <br /> Ifli\(Pe/vrlcoSSlation Tests are NOT requited DESIGN RATE: SS U I1 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 DEPTH TO GROUN DWATER-I NCHkSj CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B 7 13- <br /> �� 7� N�� > /5; <br /> B- S <br /> B- <br /> PERCOLATION TESTS <br /> 1TEST DEPTH WATER IN HOLE TEST TIME DR I WATERLEVEL-INCH5 RApERINCH MINUTES <br /> f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RIOD1 PERI D2 PERIOD <br /> P- <br /> P- /CY7 5 <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 /> Q <br /> r <br /> 1l L4en <br /> / <br /> I a <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 COMPLETED ON: <br /> ADD SSCERTIFICATION NUMBER: PHONE BER(o ionall: <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R, 10/83) —OVER — <br />