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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, � DIVISION <br /> 69 <br /> LABOR AND" PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION. TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> SEJ/4 ISE'/ 2 /T 1N/R �sE ( ) S EAST AP- <br /> COUNTY: MAIL( GAODR SS: <br /> CNR \LE5 NENN)NCSN �JALrJurt RES IJ ) 5 oz <br /> USE DATES OBSER ATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: F S: A TESTS: <br /> ❑Residence Z 1 <br /> ^ / ❑New �RePlace <br /> RATING:S=Site suitable for system U=Site unsuitable for system l L J I L7 <br /> OMSTI❑U MYIS ❑U ING®J ❑U E: SV®J I❑UL EIS OU OLDING RWNVEry1lONAL (optional) <br /> It Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the • I <br /> under s. I LHR B3.09(5)(b),indicate: ` Floodplain,indicate Floodplain elevation: ry <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL P H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED EST.HTTH-EST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 2 9q.2 NorJ[ �$ 0"G $IMS - WINS �a$ �� fJ111S W CYt11dlT�f1 <br /> B- Z <br /> '12- 9 NONE 65 0- >3ms 'I S NYns 65- 72.5NM5WRCmdw� <br /> B- 3 I 77— 9$1 NorJ6 103 O� '1BIms "1- � rJmS (,3- '7ZBNmSwRun mo <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER L V L-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERI of PERI D2 PERIO PERINCH <br /> P_ I 2 V S ` 6 kF9 3 <br /> P- Z NO 5 It 3/ <br /> P-3 IJ o Yd 3 <br /> P- <br /> P- <br /> P. <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- <br /> zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION 9 <br /> i T <br /> 1 �t <br /> I �VJH <br /> !c I <br /> i I <br /> MyRlLK <br /> 30 <br /> I <br /> O z <br /> I , <br /> I Sys. <br /> I , <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods speci iedi the the / <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of m knowledge and belief. `y�J 96 <br /> NAME(print), TESTS WERE COMPLETED <br /> 1C HR2n � - 17- - l)3 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional); <br /> 2--7 -7&0 j4wX 3S LJEs I WI . 5`1893 3670 IS"$G6" y 157 <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) -OVER - <br />