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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON W 969 <br /> HUMAN RELATIONS <br /> (H63.09(1) & Chapter 145.045) <br /> LOCATION: SECTION: NSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> i.t E 1/�1/4 � /T Y{ N/R/s—E (off r e Fig ck i s A I° <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS PER OLATION TESTS: <br /> 1� <br /> Residence �<New ❑Replace <br /> C�� I v ✓ ��" T 1 <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ❑S ❑U [IS ❑U ❑S ❑U ❑S ❑U I ❑S ❑U ���. 0 <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s.1163.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> I <br /> B go l 00-'O 110NE 790 <br /> B- <br /> B- <br /> B- <br /> B- <br /> B <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH <br /> P- <br /> P- <br /> P- f <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 /> S� jlrr..i�I}r3r M XJ <br /> !, TN <br /> .1'OwN !tc>,ril:: B�•n kT�cr`h'r.: <br /> loo L0 <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 Wisconsi <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 /> NA (print l: TESTS WERE COMPLETED ON: <br /> �LD (Jf' / ' —2—--„a <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> CST GN UR <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />