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DEPARTMENT OF DEPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR P.O. BOX 76 <br /> HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON W1 53707 <br /> LOCATION: SECTION: TOWNSHIP/MUNICIP LITY: LOT NO.:BILK NO.: SUBDIVISION NAME: <br /> .9F_ BIW/ 3 /T�I�N/R4 II(or)WI <br /> or)W 4 _/4 <br /> .j <br /> C UNTY: OWNS 'S BUYER'S NAME: MAILING AD KESS: ` <br /> r n C Q r be S S S c� �0 / -S9 f r d et 4 C A; e osS�e c <br /> USE DATES OBURVATIONS MADE <br /> NO,BEDRMS.: COMMERCIAL DESCRIPTION: R p S: R A TESTS: <br /> Residence ew ❑Replace <br /> RATING: S=Site su' le for system -Site unsuitable for emFcoNv /' v <br /> EIENTI ONA MOS. IN-G1121 <br /> 1 : SYS❑TEM-IN-FI HOL �G T❑ANK: R r' N7E ` M:(oPticr C-1 <br /> [un'deer,c,.H63.09(5)(b), <br /> otion Tests are NOT required DESIGN RATE:S STEM EL I If any portion of the lot is in the <br /> 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.ONN'BACK.) <br /> B_ l��e o O � O N � p? il �r � /r�x <br /> 9P f <br /> B-4 j%q � I / 0`/ 1r ` f/ 1160 <br /> r Ir <br /> B-3 d y y �� I 11/ /f 6/f 6"11 73 -1 <br /> -1 <br /> B- U <br /> B_ <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 PERIOD PERIOD PERINCH <br /> P- <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 /> �Z� e Xis ri h - <br /> r <br /> M Go ci <br /> Fi�� <br /> 1 � <br /> o <br /> 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specifie I 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 /> AT <br /> (prin TESTS <br /> �WERE <br /> `COMPL TED ON: <br /> Q CV' /C Q1 �I10 <br /> D E <br /> A SS: CERTtFIC TION NUMBER: P ONE NUMBER optional): <br /> r s- <br /> Z__'A <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 />