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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR ANDS- PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPA 1TY: LOT NO.:BILK.NO.: SUBDIVISION NAME: <br /> ,�^ � 3 /T t N/R/61D(or)W v/r,4 a A <br /> COUNTY: OWNER'S BUYER'S NAME: IMAILING ADDRESS: / G <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIALDESCRIPTION: N I-MOFIn DESCRIPTIONS:JPERCOLATI06T,FfTS: <br /> Residence New ❑Replace '57_.S <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONV STIO❑NAL: MOUND: ou IN-GRO�D URE: SYSTEM-IN-FIjrCHOELDING TA :RECOM�ME�STEM:(optional) <br /> If Percolation Tests area NJOTT required DESIGN RATE:SYSTEM EL If any portion of the lot 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. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B-2 7�- a 7, -- "�-,�5 yb a s <br /> — * <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUM ER INCHES AFTERSWELLING INTERVAL-MIN. PERT PERIQ.Q 1 PE 1 D2 PE D 3 PER INCH <br /> P_ 0 S <br /> P_ C , <br /> P- <br /> P- <br /> P- <br /> P- <br /> PLAN VIEW: 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 slop. <br /> SYSTEM ELEVATION <br /> 74e r 't <br /> �,MIS G r � -fit 11►R� � `�I ` i�, <br /> �= J <br /> • <br /> . �sr <br /> i fc� E 1 v <br /> r <br /> 1, the unders her t e soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin <br /> Admimistrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> NA (pnf 0: TESTS WERE COMPLETED ON: <br /> DRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): <br /> s r- Us s c_ ' . � �' 7 ?ks-- L yi <br /> CST �NAT}JRE: p <br /> DISTRIBUTION: Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester. <br /> DI LHR-SBD-6395 IN.03/81) <br />