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DEPARTMENT OF REPORT ON SQA, WRINGS AND SAFETY& BUILDING; <br /> LABOR <br /> AN /� DIVISIOP <br /> LABOR AND PERCOLATIN (115) MADISON WI 790 <br /> HUMAN RELATIONS <br /> ZA ION: E I TOWNS P LK NO.: SUBDIVISION NAME: - <br /> U TV: OWN <br /> USE <br /> �,/ DATES OBSERVATIONS MADE <br /> YJResidence /7 WNW <br /> 1'••7^fir � �� ' , <br /> RATING:S-Site suitable for system U-Site unsuitable for system <br /> O VENTI NAL MOUND <br /> ou os: u IN-GRUONDER u T NK:RECOMMENDED SVSTEMaoptonall�se <br /> os S <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> It my portion of the lot <br /> [nder s.H63.091511b1,indicate: is in the } <br /> 9 v Fbosblaln,indicate Floodplain elevation: <br /> BORING TOTAL <br /> PROFILE OESCRI►TIONS <br /> NUMBER DEPTH IN, ELEVATION BS V D UND AT •I H OF <br /> O RVED SEE EIABBRV.ON BACK'EXTURE, AND DEPTH <br /> B / q0 �/F Oo ///ONS Q 40" <br /> B-2 <br /> MAW 'S <br /> V <br /> B- 'Y 0 9y� /NONE 70 '' Gtr r <br /> B- 0 qd do*J > oil A <br /> B-6 416N > 88 <br /> PERCOLATION TESTS <br /> NUMBER INCHES FTERSWELLOING LE INTERVALf--MIN. H <br /> ­RATERMINUTES <br /> P_ -91 AA26�9_ PERIOD a <br /> PER CH <br /> 76 <br /> P. o O z <br /> P. / <br /> P- 2 <br /> P- <br /> P. Z <br /> PLAN VIEW: Show locations of percolation tests, soil borings and the dizonta ,of suitable soil areas. Indicate scala or distances. Describe what are the horn <br /> of land <br /> end vertical elevation referents points and show [hair location on the'plo( P40. Show the surface elevation at all borings and the direction and <br /> of land dace. percent <br /> SYSTEM ELEVATION qt*.P'. <br /> AmeJ 0oREqoN/000 <br /> + - _., Ali A<' � i�+T ARE/4 <br /> t Ad <br /> Lq <br /> Soo a �. <br /> OF •5uRU6y P/PE p� v <br /> _ /00100 <br /> ,DO. A i • � � Q�y T <br /> B4 s:I <br /> Sm' moo' / D . <br /> I, the undersigned, hereby certify that thes tests reprtteed on this form wan <br /> nMda byIn aceord with the proceduremethods specified mespeeifiad in the Wi sin <br /> the Code,and that the data recorded and the location of ttam an otannat b aM pest of my knowledge and belief. <br /> NAME (print : T TS WERE COMPLETED ON: <br /> �,�tiv�y soN r6 <br /> ADDRESS: <br /> UERTI FICATION NUM R: ONE NUMBER(optionall: <br /> 5- <br /> S AT <br /> I <br /> DISTRIBUTION: Original-Local Authority,2nd page-Bureau of Plumbing,3rd papa,Propoftov rear,4th page�Soil Taster. <br /> DILHR-SBD-63951N.03/811 (f'L_� <br />