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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON W 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: OWNSHIP/MHNiGipAbP;_V1 OTNO.:BL,NO.: SUIVISIONNAME: <br /> u4ETQ uu 3 Mel- G <br /> s�/ VO <br /> CO TY: MAILINGADDRESS: 7[/� <br /> A1111'all- ?i e � . <br /> USE DATES OBSERVATIONS MADE <br /> rrte�{{ NO.BEDRMS.: COMMERCIAL DESCRIPTION: � /�(�TESTS: <br /> 161Residence New ❑Replace 77: <br /> /7/`9G 7 <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> O STI❑U . MO S. OU IN-GN S ❑U E SY❑S I[,� K:L ❑SG TAN RECO^MENDED SVSTEMaoptional) <br /> If Percolation Tests are NOT required DESIGN RATE: If any pfLorrrttiilonn of the tested area is in the <br /> under s. ILHR 83.091511b1,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. HIGHE�T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> / <br /> mPd,s <br /> B > />'lOnt > 7�" <br /> B- 3 9�� x-lone- > 7'� <br /> B- `t 9Y /JO/)f > O <br /> B-J 99.V ,t/017C, > �Z,? rr� Cz5 <br /> B- <br /> PERCOLATION TESTS <br /> YTEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> T NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I P RI D2 PERIOD 3 PERINCH <br /> P- <br /> P- <br /> /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 /> I i t <br /> PSG <br /> ( <br /> i E i <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 /> NAME print TESTS WERE COMPLETED ON: <br /> �hv m 9W <br /> AulwLD RESS. CERTIFICATION NUMBER: IPHONE NUMBER(optional): <br /> CST SIGNATURE: <br /> / <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD6395 (R. 10/83) —OVER — <br />