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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,WI 53707 <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCA SECTION SEC �� TOWNSHIP/MUNICIPALITY:, ILOT .:BL�O.: SUBDI VIS SION NAME: <br /> 1 1/ /T N/ <br /> (or)W ac QN AJ <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> f Geor o XT 4)6-8 TRK Gli S <br /> USE DATES OBSERVATIONS MADE <br /> I�I�I�INO.BEDRMS.: COMMERBEDRMS.: COMMER IA LDESCRIPTION: PROFIL DES R PTI NS: PER OLATION TESTS: <br /> y�Residence ❑New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> TISMOUND: IN-GROUNCcD�PREStSt''URE: SYSTECcM-IR-FILLHni i I!cNG TANK:RECOMMENDED SYSTEM:(optional) <br /> �C �� DJ �� �J F]u �J �U nJ �u <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(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 ACK.) <br /> 0-481K31 6-35B..+s3r- 3S-b98ru.n 1 69-/32�ihJ <br /> B-1 /yy 98' I NoL X32 ,3z-jj as N rftj <br /> Mal- <br /> B- <br /> B- <br /> B- <br /> B- <br /> B_ <br /> TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODI PERI0132 PERI D PERINCH <br /> P <br /> P- <br /> P- <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 9.elevatioat all bor ngs and thedirectionand percent <br /> of land slope. S09)e )y'= 10 t-X"_t I.s7 hcYt N1o9 d <br /> SYSTEM ELEVATION BM 1°Z' <br /> �1 . SANS LA�ti <br /> Ila/ <br /> t wE ll i <br /> 3 <br /> N � f N <br /> 49..L <br /> p ii.r U�r << RoA➢ <br /> grs"x ro ' Te do W .,.• <br /> I,the undersigned, hereby certify that the soil tests reported on this to m 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 /> NAy (pr nt)' TESTS WERE COMPLETED O <br /> `i� � -�r`I � � � 3 �g7 <br /> ADDRESS: CE RTIFICATI N NUMB R: PHONENUMBERIoptiona0: <br /> aa <br /> SI NAT RE: <br /> 117 <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. GLIT <br /> DI LH R-SBD-6395 (R. 10/83) —OVER — <br />