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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> DIVISION <br /> INDUSTRY, <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATfONS HR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: OWNS /MUNICIPALITY: OI NO.:BLK.NO.: SUBDIVISION NAME: <br /> NFT rJ�1/ �o /T' oN/R/lPE for ,2? — -- <br /> COUNTY: MAILINGADDRESS: �y�- 3/y/7 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEORMS.: COMMER AL DES RIPTION: STS: <br /> Residence New ❑Replace !'2 <br /> RATING:S=Site suitable for system U=Site unsuitable for system ,/�/y ���-e,•.� <br /> ONVf NTL: M®ND:❑� IN-GROUND�Ea'SURE: S SOTEM-IN-F_ILL OQLDING®NK:RECOMMENDED SYSTEM:Igptional) <br /> ®S S IL'D DESIGN ATE: <br /> S ®U S U �f1/ <br /> If Percolation Tests are NOT required # If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: •� / Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH T GROU DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED TO BEDROCK IF OBSERVED SEE ABBRV.ON BACK.1 <br /> g_ � 9- <br /> B- � -71 � �• y ErC� <br /> S611fA -s- 30" � s/ r . 3hg_B- 3�% 9y /D 7 6- 5" FS// •� 5- 35/,fn >i ✓. 3�_ cv�''/ncS� <br /> B- S -7/11 93. y , <br /> B- <br /> PERCOLATION TESTS <br /> •, TEST DEPTH WATER IN HOLE TEST TIME D I WAT L V -IN H RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. RI D1 P RI D2 P/ PER INCH <br /> P- <br /> P- <br /> p- <br /> P_ <br /> p- <br /> P_ <br /> -PP- <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. i <br /> SYSTEM ELEVATION <br /> -- <br /> s!� r ) t <br /> �?`7t <br /> Y <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and me hods 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. s � 9Q•7 9 <br /> NAME print TESTS WERE COMPLETE <br /> c <br /> ADDRESS' CERTIFICATP N NUMBER: PHONE NUMBERIoptionall: <br /> CST SI ATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />