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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY,- DIVISION <br /> HUM <br /> iOAN RER ANOLATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> D <br /> ATION:t S SA <br /> TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> �/4e5j /' /T�' N/R/ E (p 7 ( <br /> COUNTY: OWNE R'SBUYER'S NAM E: MAI LING ADDRESS: <br /> 1 75 26ry iL <br /> USE DATES OBSERVA IONSM DE <br /> BEDRMS.: COMMER IAL DESCRIPTION: „.�,,// R NS: A TESTS: <br /> 1-iResidence c LIJNew ❑Replace <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> CONVEIVTIO❑NAL: MOUND IN-GROU Pa URE: SYSTEM-IN-FIkLH EJS TANI$: RECOMMENDED SYSTEM (optional) <br /> rU� U SiR, — U S L��J1(J� S LrJj}Y( Ua /— lv <br /> I <br /> Percolation Tests are NOT required DESIGN RATE:SVST M L V. <br /> Q If any portion icthe lot is l the t <br /> under s.H63.09(5)Ib),indicate: �� S-` � !r Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> 'BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.I <br /> 98• <br /> B - <br /> 97 <br /> [B7 <br /> v3: <br /> aM � , . „ PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD PERIOD2 PERIOD PER INCH <br /> P —_— ___----. <br /> P- ZD <br /> P- <br /> P- <br /> P- '/ a, <br /> PLAN VIEW: Shaw 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 slop. <br /> SYSTEM ELEVATION <br /> z <br /> AL <br /> � 3VIP <br /> NYN \ AL <br /> "Y <br /> T N <br /> 71 <br /> 1 y <br /> ©`s lf'2f 10Y O/'i/l7r.'!Yy S.�i flrYl \s a �m — /yyS•y,�l <br /> -Yl- <br /> /ot J <br /> ioo`o ” <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin <br /> Admimistrative 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 /> ADDRESS: �� ��— CERTIFICATION NUMBER: PHONE NUMBER optional): <br /> r OA <br /> DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 'J page-Property Owner,4th page-Soil Tester. <br /> 01 LHR-SBD-6395(N. 03/81) <br />