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D0IF.{VTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRUSTRY, DIVISION <br /> LABOR HUMAN REILATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (H63.09(1) & Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP'^"""—"�-"'"-'��— LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> S4 '/a '/a �3��T39N/V� ( 4 [E �E <br /> COUNTY: OWNER'S MAILING ADDRESS: <br /> Not— ALIM1 --5'V.73PRMO, t/e, S: owls .. Wig" <br /> USE DATES OBSERVATIONS MAD <br /> NO.BEDRMS.:JCOMMERCrIYESCRIPTION:j PROFIL ES IPTI NS: PER OL 10 S <br /> ce 1k ,� ❑New place � r <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> sO NTlOXS ❑NAL: MOU D:❑� IN-G N PR7 RE: SYSTEM-I�LLH0LLDING TA K: REC �� ED SYSTEM:(optional)3cAPv <br /> BrZD <br /> If Percolation Tests are NOT required DESIGN RATE <br /> Q If any portion of the tested area is in the <br /> under s.H63.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- <br /> B- <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 PE IOD2 PERIOD 3 PER NCH <br /> P- �'� / 11 <br /> 7i <br /> P- _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 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 "a'C' tLE '.q` lmi rop oj <br /> / dN • OVS4 -E L -/CO <br /> l7 ti <br /> aRC Tests <br /> SAKE. <br /> cc� Limit= <br /> t <br /> I,the and rsigned, 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 MP ETE ON: <br /> ADDRESS: CERTIFI ATI N NUMBER: PHONE NUMBER(optional): <br /> CST SI N TUBE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER -- <br />