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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND - PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBD VISION NAME: <br /> 1/ %I /T N/R E (ar)W <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: A STS: <br /> ❑Residence El New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVEccNTIONAL: MOUNcM IN-GROUNDSTEM-IN-Fl LLHOLDIINcNG TANK:RRECOMMENDED SYSTEM:(optional) <br /> �J �U ElJ �� EIS � I EIS EJU DJ EIY <br /> If Percolation Tests are NOT required DESIGN RATE:SYSTEM If any portion of the lot is in the <br /> under s.1­163.0915)(b),indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL P HTO R -INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION. OBSERVED <br /> EST.HIGHE TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> B- <br /> B- X3 . 8 <br /> B- 93, <br /> B- <br /> B- 47,91 <br /> B- 3. <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 I P RIOD2 R T= PER INCH <br /> P- <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 disti nces. 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 borii gs and the direction and percent <br /> of land slop. <br /> SYSTEM ELEVATIONa <br /> { , I <br /> t <br /> r <br /> I <br /> i <br /> ' ' N <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by ma in accord with the procedures n ethods 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 /> NAME(print): TESTS WERE COMPLETE ON: <br /> ADDRESS: CERTIFICATION NUMBEF PHONE NUMBER optional): <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester. (r <br /> DILHR-SBD-6395(N.03/81) <br />