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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY& BUIL OS <br /> INDUSTRY, . - DIVISIISI ON <br /> LABOR ANDP.O. BOX 7969 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (I LHR 83.0911)&Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT N0_T9_G -NO.: SUBBtYJStAN�JAME <br /> 4,</ <br /> 4 it/ <br /> CO NTY: MAILING ADDRESS: <br /> r c7`t ,� ��or� Siren, ie/I .��P7o2 <br /> USE DATES OBSERVATIONS MADE <br /> Ix <br /> NO.BEDRMS.: COMM R IAL DES RIPTION: TS: <br /> IdlResidence ? %New ❑Replace <br /> `J ,f/o% x/ov. /o, /9� <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> $ ❑u IZs ❑u 7 ct/ <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09151(b),indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DERH_T R UN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPT-H IN, ELEVATION OBSERVED E T TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) <br /> B- > O-9"BQQ/�/,' 9p SS"GLS med. <br /> MCC/. 3...'S7'•— ��'iQ fLvY�PGG' 3 <br /> Co0",B'7Merl S' &0, 27"f ce�l�c 5 <br /> > 7_� O-r'elc/,• Y'- S.s B/?me�is; 7-?" ec a� rs <br /> B- '" 910. Nahe > <br /> B- <br /> if PERCOLATION TESTS <br /> CTEST DEPTH WATER IN HOLE TEST TIME <br /> f DROP IN WATER LV HS RATE MINUTES <br /> INTERVAL-MIN. RPERIOD 2NUMBER INCHES AFTERSWELLING INH <br /> P- On J <br /> P- D" e <br /> O P 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 stale 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 1borings and the direction and percent <br /> of land slope. /"—(�' eYCef07 /,1/{lUG �feGl� <br /> SYSTEM EVATION 9V -- <br /> I <br /> It <br /> I <br /> I I <br /> » <br /> LL <br /> Q a ov44 <br /> - _ <br /> rt <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 /> ADDRESS <br /> ,:� CERTIFICATION NUMBER IPHONE VZER�I/op�tino na1). <br /> X—V //Q:�7 �ve.� /•0. ��f✓ �,t� 7C� �� c� L-?5-�✓ 7� �OIO- pf d�0 <br /> CST SIGNA/TUR E: <br /> a� <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) — OVER — <br />