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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 /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MHP/iQPR 64iY: OT NO.:BLI6 N9a SUBOIV ISION NAME: <br /> �/ 1/ 11WH/�/�oE foc i ruci <br /> CO NTV: MAILING ADDRESS: SS <br /> h r .� <br /> USE 'qZDrATES OBSERVATIONS ADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: A TESTS:Residence New Replace z X990 z g <br /> �r—i y <br /> RATING: S=Site suitable <br /> for system U=Site unsuitable for system dry ��y-y,� <br /> Off!�TIQU MN IILV�l �U IN GPS ❑U : SVS❑TEM-IOUL O❑S 5QU R� On�ECOMMENDED SYSTEM: ional) <br /> If Percolation Tests are NOT required DESIGN RATE: S If any portion of the tested area is in the <br /> under s. ILHR 83.09(511b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALP H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED E9T7U 7HST_TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- l " 7, 0-6-w/_�O/ > <br /> B- arc > 7 1-50" a-5 161 <br /> B3/ �7 Diol ",D,� ,dn /5; <br /> g_ ?6,,5 <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> E NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER 7' <br /> RIODt P RI D2 PERIOD PERINCH <br /> p- 3 <br /> P- 3 <br /> p- x Inke. 7 <br /> P- <br /> P- <br /> IP_ <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 ELEVATIONf rL/fief�� <br /> /SOD. <br /> ono t N <br /> 6016-"? Za7p <br /> I P� yS/5 <br /> 1, 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 ITESTS WERE COMPLETED ON: <br /> *VV <br /> ADDRE S: CERTIFICA ION NUMBER: P ONE UMBER(optional): <br /> MP3 5 _ <br /> CST SIGNATUR <br /> Gc I ?�7 <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />