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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, REPORT <br /> DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON BOX WI 7969 <br /> HUMAN RELATIONS <br /> - (H63.0911) & Chapter 145.045) <br /> LOCATION: SECTION: ITOWNSHIP/MUNICIPALITY: LOT NO BL : S K.NO. UBDIVISI N NAME: <br /> /a J /T'/� N/RISF(or)W "s �- .: �c� ,��s <br /> COUNTY: OW 'S/BUYER'S NAME, I MAILING ADDRESS: /� <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: IP FILE DESCRIPTIONS:1PERCOLATION TESTS: <br /> Residence VNew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system l �/ <br /> CMMSEU <br /> L: MOUND: IN-GROUND PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ©S ❑U �S ❑U DS ©U ❑SCSU Co &/V <br /> If Percolation Tests are NOT required DESIGN RATE: 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- C (� 1 j 1 O �� / 11'er 4-7 u . J <br /> B-31 !?0 _/ 0 ly 0 Y"'Aty'V I r q/, "( 4 c <br /> B � /�� � � t � o � �s CS <br /> B- s gtc of 78a 76 <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD z PERIOD PE_R INCH <br /> P- O rN�Dn v S' 7 <br /> P_ .�-- S- V �~ S 0 c� <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 <br /> 1 j <br /> I I d <br /> C <br /> 1 j <br /> I � <br /> i <br /> j <br /> ! <br /> (( f <br /> VP <br /> i <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by m n accord ith 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 y knowledge and belief. <br /> NAME(print): TESTS WERE COMPLETED O <br /> 19c) y <br /> ADDRESS: I CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> '37 171s--f&_6 ¢i/s Il <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />