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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, - _ DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 7969 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION:Eg1/ 0]WECTIO�Tp N/R/SII'(or)W TOWNSHIPW.-' Ffet+TYti LOSNO.:BLA��,: S IVIS�3 i/� ECOUNTY: CNER'S/BUYER'S N ME: MAILING ADDRESS:s-K ,„, �/ 3 / <br /> Air nsr �r e D 9, ST-P <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRNIS.: COMMERCIAL DESCRIPTION: (PROFILEDESCRIPTIONS: PERCOLATION TESTS: <br /> �fesidence / ❑New Replace L !/ A _O P /!.. ��O ip <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> WS [:]U ®S ❑U ®S ❑U ❑S XU ❑S CSU ea .vv. <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> q If any portion of the tested area is in the <br /> under s. LHR 83.09(5)(1 indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV,ON BACK.) <br /> B- 71)- 010 Moue 77X o-(, "R44j- 6 '/v "8n lnvcls <br /> B-J-- 80 8,40 1% 7 �0 - !s =/b" B� 1s /6 - 80 ° CS <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PER PERINCH <br /> P r A> o S01 2- ?- T <br /> P- 6- 3 7 tj c 11 <br /> P-3 N 0 S 3 a 3 i/ <br /> ILIP- <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 /> Rove <br /> C�E`t �,4rv.�o 3'GP4r <br /> r-e g4Ill'r d <br /> 'circ # <br /> 3o 7/7 <br /> i6m 100 t N <br /> x ptrs VQ/1. :-V NO <br /> 0 <br /> �\ I, a unde igrd, hereby certifyy that�1kl Tests'rep ed on this form were made by me in accord with the procedures and methods specified in the Wisconsin <br /> Admin istrati a Code,and that tt(e 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 /> edvv tc ►1 6 /t�NS < C d <br /> ADDRES �}-- CERTIFICATION NUMBER: PHONE NUMBER(optionaW <br /> �. :S Ise r" UiL S q A S"F /3-q <br /> CS I N TURF <br /> 2 <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. r <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />