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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> DIVISION <br /> INDUSTRY, P.O. BOX 7969 <br /> LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707 <br /> HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: �Q TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME,41 : <br /> k,"/ y 3 /Tn N/R/9 E (or(Cj '0 n/ <br /> COUNTY: MA I ADDRESS: <br /> /3orn / / Ej� r a /3 3�x 7 V 9 ) d r r w r I,l. <br /> DATES OBSERVATIONS MADE 3 Y 71 <br /> USE O S: 1O TES S: <br /> NO,BEDRMS: COMMERCIAL DESCRIPTION: I%/G/ u <br /> �' Residence ^t / A ❑New ®Replace / ✓A <br /> RATING:S=Site suitable for system U-Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROOM II I ESSURE: SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ❑S ®U 0SEU1 EISMU ❑S IA ©S DU J <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: I A Floodplain,'nd icate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D P H T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOfl,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. Z_ TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- os f c -B- 5B- /� / i X /j <br /> Ala rt <br /> PERCOLATION TESTS <br /> EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERI D2 P R PERINCH <br /> P- <br /> P- <br /> P- <br /> P- <br /> R <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 /> dna_ id 0 - <br /> TN <br /> Uj <br /> _ - <br /> l� ai'n -8M <br /> _ � Sl b <br /> l i <br /> I,the undersigned, hereby certify at the soil tests ep ed on this form were made by me in accord with the procedures and methods specified in tj Is Wise)nsin <br /> Administrative Code,and-.that the. a re ocation of the tests are correct to the best of my knowledge and belief. <br /> NAME (print TESTS WERE COMPLETED ON: <br /> / w1 <br /> e__r-f'r ✓ / P ! Y 6 <br /> ADDRESS: CERTIF ATION UM E PHONE NUMBE�Zfl(iptiort@I): <br /> CST GNATU <br /> �p. <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. �F �, / <br /> DILHR-SBD-6395 (R. 10/83) —OVER — ; <br />