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4—�' <br /> DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 7969 <br /> HUMAMG ELATIONS <br /> LOCATION: �• SECTION: - TOWNS/�HIP/M NICIPA TY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> ,{1 4 4 /T*N/IVB e(or)W 0q I i@/L <br /> C UNTY: OWNER'S BUYER'S NAME: MAILLIIN–G ADDRESS: <br /> qr" <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: CRIPTION: S: LA TESTS: <br /> Residence �1 ❑New >Oeplace /_ a / Q k -�j �S.�' <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CO�ENT01.1 MOUND: <br /> O� IN-G®S OU RE: SYOSTEM-IIKU OLDS NQ : RECOM0ENDED SYSTEM:(optional) <br /> If ILPeeerrllcollation Tests are NOT required DESIGN RATE:S ST SS UU If any portion of the Clot is in the <br /> V <br /> under s.H63.09(5)(b),indicate: I 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. 1 HEST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) <br /> > F0 " & 4s 1,1 '.' 4 S /o " C <br /> B- r V (Z; ,� 0 4 E' `;8e1 h S f t t 4_s Fit C 1 tt M J <br /> B-,�' 8IZ� a,_ � � G4B.zl� 0 " 45 9 c �� ifMS <br /> B-( Yt 1> 16`` i 4 14 " �, u L S' M S <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RIO t PERIOD PER PERINCH <br /> P- a i <br /> P- f f3 d 3 <br /> P �l r <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 /> 74'• --r1,- ifo, 17 r C rC <br /> POT4vv. n � J*6 � <br /> 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the 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 /> NA (prin TESTS <br /> WERE COMPLETED ON: <br /> AD KESS: CERTIFI ATION NUMBER: PHONE NUMBER optional): <br /> -lc_ . Lf v <br /> C AT <br /> DISTRIBUTION: Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th pageSoil Tester. //C•. <br /> DILHR-SBD-6395(N.03/81) <br />