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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON69 <br /> W 53707 <br /> HUMAN RELATIONS <br /> (1463.0917)& Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIV SIGN NAME: <br /> 0/ '/ /T35N/R/4Mr)W , urs <br /> COUNTY: OW 54 NAME: MAI NG ADDRESS: Soy <br /> /nd.NJB.0t� <br /> .0-X <br /> D C <br /> USE ATES OBSE RVATI ONS ADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: <br /> ❑New I,P,ROFIL DES IPTION : R (4TIONTESTS: <br /> Residence '1—� Replace Iy/�� <br /> RATING:S=Site suitable for system EIU U=Site unsuitable for system YYY %/V9 <br /> CONVEccNTIONAL: MOUNccD: IN-GROUNc^D Pr'RTfESII11S'IURE: SYSTECCM-IN-FILLHOLDIINCNG TA1 l RECOMMENDED SYSTEM:(optional) <br /> 21.11 F <br /> E:j <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s.1-163.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COL R,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST ITO BEDROCK IF OBSERVED (SEE ABgBV.ON V CK.) <br /> 4' dc 02 <br /> SIPB- 51 970 151- Arli Ir <br /> 7so NelNr �^AI AO - 5rr4 ;z <br /> B �S $a. Natif 6 S c <br /> e- <br /> E <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME I DROP IN WATER LEVEL-INCHESi RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. pERloDt PERI D PERIPER INCH <br /> P- <br /> O 'K a <br /> P- <br /> P w auZ <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 atall b�'gsand the direction percent <br /> of land slope. ff/ P <br /> SYS EM ELEVATION ' / �""'( �� / ' �IQ� X <br /> 9 <br /> • <br /> 9lf , <br /> u <br /> o� • . <br /> yyg <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 ri t): TESTS W RE COMP ET ON: <br /> C <br /> z <br /> ADD ESS: CE TI ICATI NUMBER: PHONE NUMBER(optional).: <br /> 5- -/ 5` /77 6 fib/ <br /> CST SIG5NA <br /> URE: <br /> Nf <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />