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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND P.O. BOX <br /> 969 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 537073707 <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP1.11 f hE'FP_1ITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> '/ — '/ 1 /T#oN/R/5e (pr)W c e, A/A� iA <br /> CQQUNTY: OWNER'S/BUYER'S NAME: MAILINU ADDRESS: <br /> 6 I A ` I-4N.! W CQ I t oft <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFIL DESCRIPTIONS: PERCOLATION TESTS: <br /> Residence 1 New ❑Replace I 0 0,_r <br /> RATING:S=Site suitable for system U=Site unsuitable for system Q / O <br /> ONVENTIONAL MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FI LLHOLDING TANK: R ECOMMENDED SYSTEM:(optional) <br /> ®Sou [�S ❑u ®S ❑U ❑SK EISIgUl C2apU <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.0915)Ib),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH N. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) / <br /> B- I go 10 'A- /V toot g id 7 "et /d " Cr 6 /! " PV.% <br /> B- 10 1 .S 7� y"Oli �S /O " �J r wtt.r �S <br /> B- 3- O J , \ 7 0 10 <br /> 0ro k L Jr � C r 6� " YIM'G / <br /> B y"Betr <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD2 PER PERINCH <br /> P- a M o !A \? 3/ i3 / <br /> P_ 8— U o !o �/ <br /> No d 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 <br /> Mid <br /> L <br /> a <br /> ' 0 �SLO <br /> �� _ —'l p•wl TN <br /> b s <br /> fill <br /> f' 74 <br /> j s7 Act <br /> � <br /> r Y I 1 (o �/0 �7 Sof/W <br /> arrq <br /> I, the undersigned, 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 /> NA E (pri ): TESTS WERE COMPLETED ON: <br /> d V'P If a 'I lel (- 1 Q —/ _ 9 r <br /> AD RESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> ,c <br /> CS NA URE: <br /> n " <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395(R. 10/83) —OVER — <br />