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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY,- DIVISION <br /> 7969 <br /> LABOR AND /� CC P.O. BOX 3707 <br /> HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON,WI 53707 <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: ,/ SECTION TOWNSHIP/ OT NO.:BLK.NO.: SH88�1'!�E'� <br /> T N/W E (o <br /> c1,�aP.� / 1�Q�ri MAILING ADDRESS. & <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMIS.: COMMERCIAL DESCRIPTION: I7hOFILEDES A S:TEST <br /> Residence c-;;,? ❑New Replace /5/9O /-? / <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONV NTI O❑Nu . MU S' Du IN G S Flu E: SVS❑TEM-I ILL OL❑DING TA K:RE S,1fN �T Ptiogal) <br /> S DESIGN RATE: SS UU SS U i <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),ind I I Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUPDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED ST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> s'o o6 .dpi 15,',l <br /> B- �3 3 ,t/o/�e� > 7v3 'V1 67 co,-n as <br /> B 3 9,/ �} �(/o�e� ? ���Sc ��f'&5 „ Xma c <br /> B- `f <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> ESi DEPTH WATER IN HOLETEST TIME DR I WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER WELLING INTERVAL-MIN. p RI D1 P RI D2 P R PER INCH <br /> _ <br /> P- <br /> �e '5_ 7 / <br /> P " aVS <br /> P- GY7 <br /> P- <br /> P- <br /> LP- <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�• 3a/e /" �O <br /> ¢ _ r <br /> P3 e <br /> o Pi <br /> � m <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 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 : TESTS WERE COMPLETED ON: <br /> C.c/fie IC51 l" 3, /49D <br /> ADDRESS: CERTIFICATION NUMBER: P ONE UMBER(opti0nal): <br /> Q� /03 k 1(f&x' ' 11./T �5 %0 S <br /> CST IGNATUU/RE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR.SBDE395 (R. 10183) -OVER - <br />