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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, - DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> �r (H53.0911)& Chapter 145.045) <br /> LO;`sTJ Q% '/ T pN/R/Salor) n SECTION: MUNICIPALIOTV: L/ .:BL 't: SUBDIVISION NAME: <br /> C LINTY: R'Sa v MAILING ADDRESS: N/JJ- <br /> /' 'E I On rp <br /> USE DATES OBSERVATIONS MADE <br /> V�{{Residence NO.BEDRMS: COMM ERCIAL DESCRIPTION: PROFILE DES R TIONS: R ATIONTESTS: <br /> IHlNew ❑Replace I� .• `G� _ 1�� � _��1 _� <br /> RATING:S=Site suitable for system U=Site unsuitable for system Y 4 <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURES STEM-IN-FILLHOLDINGTANK: RECOMMENDED SYSTEM:(optional) <br /> RS ❑U ®S ❑u ®S ❑u 1E]SWEISNUI c6AlV <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s.1­163.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTHTOGROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- f e / Oa, oPjiz-, �'n "fee?1 8A c_ S <br /> B- Yo 101, 1? is 7 0 "&W III l i. w c S <br /> B-3 ff o d / If t 1 > e o "491!A S- " Al c s <br /> B- Y_ 9 () 104 If 780 '6' s <br /> B-S' F0 10 /. 11 A 4,Z5 7S <br /> << C_ <br /> B- 6 g0 d ( � 7 Pd Ir 4,eo es f7tf /� C <br /> PERCOLATION TESTS �J <br /> TEST DEPTH WATER IN HOLE TEST TIME a-----+ DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD P R PER INCH <br /> P- L16 ji 0 as ♦ <br /> P- ;1 3 All o <br /> P- utoM. 3 i <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 <br /> P p r-c <br /> P <br /> f esr c <br /> or <br /> ar, 07 r <br /> _ f _ ; skif `fie Grrq <br /> 0 03 ✓'� /Q II L lA1 _ _�SdJY_ . ;l.yrr <br /> o 4K 8 tot <br /> fog <br /> 83� <br /> I,the undersigned, hereby certify t at th orted 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 /> NA E (Pant : j TESTS WERE COMPLETED ON: <br /> ADDRESS: L CERTIFICATION NUMBER IPHONENUMBER(optional): <br /> CS A RE: <br /> �G <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 IR.02/82) —OVER — <br />