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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND P.O. BOX 796 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (I LHR 83.09(1) &Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDI VISION NAME: <br /> SW'/SSE '/ 3S /T 0N/R16EIoIW p Ku <br /> COUNTY: MAILING ADDRESS: <br /> 1- <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: CO ER IAL DESCRIPTION: fir,( PROFILE S: A TESTS <br /> ❑Residence ? ��_ _ ❑New Pil Replace I /7 _ �/� - �� z7� - �� <br /> RATING:S=Site suitable for system U=Site unsuitable for system / ` / _I L <br /> ON\ ENTI NAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLD TAN K:RECOMMENDED SYSTEM:(optional) <br /> S ❑Q NS ❑II ®S ❑II ®.S ❑U ❑S o P_0 J\1rIlJTln&fAL <br /> It 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: N/4 <br /> PROFILE DESCRIPTIONS <br /> BORINGTOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPfH IN, ELEVATION OBSERVED E HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- ) ?Z NOOC o-q NM_% `I- 12 f3dwU <br /> e-3 '71- 9l -$ 0- 10 81ms 10 -?28'rl1_$ <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DRO IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PERINCH <br /> P- 20 No 5 1i4i <br /> P- 3 <br /> P- 3 NOa 3 <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-_..at 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 go. Z — To E 9D - <br /> r <br /> ' I I <br /> I I1 I <br /> -FbMj 4 Of 51 W4 <br /> _ All t�15 ? ' <br /> 1 I <br /> i <br /> Q, I <br /> 7 i <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 me hods 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 knouvle In belief. spy (yam <br /> t : <br /> NAME (prinTESTS W C MPLET N: CJv <br /> 7 - 2-9 - 3 <br /> ADDR ESS.Z�7 60 1 CERTIFICATION NUMBER: PHONE NUMBE (optional): <br /> CSTSIGNATUHE: S S <br /> DISTRIBUTION: Original and one Copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />