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DEPARTMENTDFREPORT ON SOIL WRINGS AND SAFETY& BUILDINGS <br /> INDUS-MY, .- - - - DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON W1 5379079 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK.NO.: SUBDI WISIO NN AME: <br /> SE '/4 / N/R E Io /yE <br /> COUNTY: OW ER'S/BU ER'S NAME: AlMLING ADDRESS: <br /> $de oN zJ, s ,c Emes r6as- <br /> USE DATES OBSERVATION MAD <br /> NO.BEDRMS.: COMMER N LDESCRIPTION: PROFILE 9ESCRIPTIO S: PER AT NTESTS: <br /> Residence � ❑New LJQReplace �J <br /> RATING:S=Site suitable for system U=Site unsuitable for system // \\ 6 <br /> C'W S O❑NU . M _ Js DU IN GxS P❑�RE: SVS❑TE M-OU EIS <br /> TANK: RECOMMENDED optio pally / <br /> S I�t�J S S (LdJ�{i� L 1 <br /> DESIGN RATE <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 DEPT TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLQR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON B CK.) <br /> B- 6� fr` E s �G" s !S R ro <br /> B n 3 9� y �S s s ~ s s" �✓ Mol` <br /> B O 3.7s` 0 toS s S" S .v vJoT. <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATERIN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER=1 PERI D2 PERI CH <br /> P iVi QN <br /> P- .,.)- <br /> P_ <br /> P_ <br /> P <br /> - aP- <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 boridgs and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION <br /> T otn sy1 <br /> �R►v� scA<� � �'uc,E� �o' TN <br /> >10 COWER pF Neuse <br /> A 'W-Re 7tsts <br /> �i,� t,4KG fall <br /> K #nycertify <br /> .BRA <br /> I,the undersigne 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 : &A) �� �� TESTS WERE gOMPLtTE6 ON: <br /> ADDRESS: 9 CERTIFIC TIO UMBEER: PHONE NUMBER(optional): <br /> CST SIGN E: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />