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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR P.O. BOX 76 <br /> HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> � 1�4JE1� /T 1N/R15Eto W WiSS EAST RRT tfA MIA COUNTY: MAI LINU ADDRESS: <br /> USE DATES OBSERVATIONS MADE <br /> XNO.BEDRMS: COMMER IAL DESCRIPTION: PERCOLATIONESTS: <br /> Residence n ��_ ❑New Replace I —10 <br /> - '2 _no <br /> RATING:S=Site suitable for system U=Site unsuitable for system '1 <br /> O,�ENTIO❑NAL: MOUND:U 14S ❑U IN-GROOS DQ E. SYSTEM-IN-FILL Els <br /> s u .RECOMMENDED SYSTE Lloptionall <br /> If Percolation Testsare NOT required DESIGN RATE: If an •fIorti <br /> y 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 ELEVATION P HT R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B NONE "17— 0-(o BIS (o-Z78MIS 2_7- 72RSc.I <br /> B- 'Z 2 q . 1 No tAE_ >7Z 0- (D' (o -Z 2 <br /> B- 3 2 97. o NE_ in - - of - 1Z s <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LVEL-IN HES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 p RI D2 p q PERINCH <br /> P- 714 NO 30 ? �� <br /> P- 31 No 3/ 51 <br /> P 0 t/h— 3/ S I L <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 FL <br /> I , <br /> PRtvy - - <br /> �BMaoo_NAlLarl�Zri�OA� _ _' _ � _ <br /> - <br /> F>,�.� <br /> FL ;a WEI1 J <br /> I 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 /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 5TEK W( S�VB 3 3(970 (o- <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR.SBD6395 (R. 10/83) — OVER — <br />