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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, �- DIVISION <br /> LABOR AND P.O. BOX 7969 <br /> HUMAN RELATIONS PERCOLATION TESTS 115) MADISON INI 53707 <br /> (I LHR 83.09(1) &Chapter 145) <br /> LOCA'/N:r 1/ SEOTIO�T"fl /SE to TQWWI PC/MUNICIPALITY: LOT NO.:BLK.NO.. <br /> Ca,LINTY: MAILING ADDRESS: <br /> CK <br /> r n,� / N �o � /Gb BaX 30l pvr'6z-7.9 r <br /> USE DATES OBSERVATIONS MADE <br /> N0. DRMS.: COMMER I DESCRIPTION: PROFILE 15ESCRIPTIONS: PERCOLATION TESTS: <br /> Residence New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTEJQ Ivf NS DU <br /> IN-GLAND-�ESSl1RE: EJSYSTrLLIHOLDI NG E�D' SYSTEM:(optional) <br /> ZSIf Percolation Tests are NOT required DESIGN RATES If any portion of the tested areais in the <br /> under s. ILHR 83.09(5)(W,indicate: NN Floodplain, indicate Floodplain elevation: �/A <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL P H T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH <br /> ©I N, ELEVATION OBSERVED ES IGHE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B l D re Cl ' C7`l % ?k <br /> /s! n > - <br /> B- 0- 7x„ 9-3 -�,t n 7� „ <br /> B- 3 7P11 93` > 7 11 S 11 Vis; I �i u <br /> B- � �a 0 9y`- , riGm2. > 7a cl S (0 11 <br /> B_ s 7 g I 9566111 P <br /> 0_y� 5 '.1 si <br /> /s/ 7 <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PERIO PERINCH <br /> P- -n / 1 <br /> P- /10-YLY n <br /> P- 14 <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 /> - - =Arh /0rSCL4kefne, -nett <br /> d00 <br /> ; atswrned4V -� -- <br /> by&0 <br /> } /5 <br /> NO well or $ f /dfr�s _oN�hf$ /of . •Qs TN <br /> dSdrvl_ In 1 bio*S L""- <br /> I 3yo <br /> t /29 TT 3QX62' w` <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 method spe ified in thfj 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. �F 9/33 <br /> NAME(print : TESTS WERE COMPLETED <br /> rj- G->a-9 <br /> ADDESS V1 nn 7 CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> -3-t-396 (:f/YaP.�{la . RC1 nbt- T q? 6 0035 <br /> CST SI ATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> MR-SBD8395 (R. 10/83) —OVER — <br />