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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> P.O. BOX 7969 <br /> LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707 <br /> HUMAN RELATIONS <br /> II LHR 83.0917)&Chapter 145) <br /> iLSECTION: TO NSHIP/ fAE4I . TNIVISION NAME: <br /> Wy fo1A- % & `1 O <br /> – <br /> CO TV: MAL ADDR <br /> /9i�0 rn��1 i/ �� c <br /> USE DATES OBSERVATIONS MADE <br /> NO.B : C ON: PROFILE PERCOLATION T <br /> Residence New ❑Replace /J 24Y 1 . <br /> RATING:S-Site suitable for system U-Site unsuitable for system �/. '�/ <br /> CONVENT NAL: MOUND: IN-GROUNDE - -FILL OL ING TANK:REC MME NO ED SYSTEM,fo tional) <br /> ❑S U ❑S U ❑$ U ❑S U $ ❑U U/CL'i7 C1/J <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under a. ILHR 83.09(5)(1 Indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUP D% ER-INCHES CHARA T R F SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION 'OBSERVED TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) <br /> B- / C/J' <br /> 74"O <br /> B- `3 sZ,�N 9713 9// 4?65 <br /> �4'C5; <br /> 17 <br /> B-s q <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES INCH <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 p ql <br /> P- <br /> P- <br /> P- <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 aro the hori- <br /> rontal and vertical elevation reference Points and show their location on the plot plan. Show the surface elevation at ell borings and the direction and percent <br /> of land slope. <br /> SYSTEM <br /> —} TN <br /> d — Aw &0 " <br /> v: _ <br /> a <br /> — A — <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 cified in the Wisconsin <br /> Administratiw Code and that the data recorded and the location of the tests are correct to the best of my knowled a and lief <br /> t <br /> NAME print): ITESTS WERE COMPLETED ON:1 <br /> QD74� /e �/ /�/ Tj <br /> ADD SS: � � � � � � CERTI FIC TlNUMBER: P ONE UJMBopt ione l): <br /> S 9 — 20 <br /> 2o CST SLV.GZNATRE: ✓C'U??/?"/"77/ <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBO63951R, 10/831 –OVER – <br />