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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, c DIVISION <br /> LABOR ANDBOX 76 <br /> HUMAN RELATI(3NS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/KMJ#0 PAt : OT NO.:BLKNO. SUBDIVISION NA <br /> /N/Ritor)W MSw'/SC '/ � /TY ME: <br /> /+ A <br /> COUNTY: / MAILING ADDRESS: <br /> role <br /> USE 21— DATES OBSERVA ONS MADE <br /> NO.BEDRMS: COMM R(;IAL DESCRIPTION: <br /> Residence rr--x�'' / TS: <br /> �,aavew ❑Replace �S � //�� <br /> � 7 <br /> RATING:S-Site suitable for system U=Site unsuitable for system <br /> O NVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SVSTEM:loptional) <br /> f97S ❑Q C9S ❑A RS ❑� ❑SZU ❑S ©U 0 A. V <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: I Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> - <br /> BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICK ESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED H ST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> Aj04 8 C� -N" h'c i s 4- "- WO "R ryy.� d <br /> B- ° w. <br /> B $ � � � t� (( ) �� f, Ilkrs <br /> 13- �5 7 CiS +� �� – ��r. B1 (j (r ` 7 � rt 4Qrynr(A <br /> B- 6 <br /> PERCOLATION TESTS <br /> EST DEPTH WATER IN HOLE TEST TIME D I WATER L V L-IN HES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P 1111110D PERINCH <br /> P 04-1 <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. Sh the surface elevation at all borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION. 9'-� <br /> _ A ri;t ;, ti E <br /> N <br /> r <br /> Oil <br /> —1 40 <br /> i <br /> I <br /> i <br /> -. <br /> `� Y... i. li-- r- -` r ice - O <br /> lt <br /> I � <br /> -- - - -} <br /> -i7 l L L- <br /> I, hie uundersiglied,'Tereby 'fy that the soil tests re ed on this form were made by me in accord with the procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the orded and a location of the tests are correct to the best of my knowledge and belief. <br /> NAME (prin0 TESTS WERE COMPLETED ON: <br /> a <br /> ADDRSCERTIFICATION <br /> NUMBER: PHONE NUMBER(Opt'onal): <br /> s77L�` .mac if ' 3 � -p k/ 1 <br /> NA URE: rl <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> 111 RR-CRn_gq Qrl fR in/Rtl -11- <br />