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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECT N: T WNSHIP/MUNICIPALITY' LOT NO.:BLK.NO.: S NAME: <br /> 15E�/ .t C 4 S /T ?BN/R/J E ( rl ,Q1-,1e1 `e Tauir,Jhi' —J _ 1161e/ Gov f Cv7- <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> iney7` (, "Vde//c 'Ofnoh`er Ao'y V/� WeZ,54-i, 44/1 n 93 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: rr��z(( PROFI LE DESCRIPTI NS: ER O ATION TESTS' <br /> Residence ❑New IglReplace /(2.q7 <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> O((NNV�VE(NTION'A'ttL: MOUND: IN-GROVNND-PRESSURE: SYSTEM-I(N�-F-F'IILtL HOLDING TT`A�NK: RECOMMEND/ED SVST M (optional) <br /> )LI� ❑U NJ ❑u S ❑U ❑.1 L1U ❑S �U CGY7VC/7T/CY7Q� <br /> DESIGN RATE: <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),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, CO OR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH N. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> B / hoz " 99. D /� ev7 >7a " %� c >73;-��"-� 7a <br /> B-a 7�?'" 99. D it/one X74 ,• o-� e/J/; "- 3a �..IJ; - ` •',e nn.S <br /> B- 3 7a" 98. 7 I/oma > 7a„ <br /> �••g/a/: S"-3Co'Brita; ,S6•,_ 7.7",e m,5 <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. <br /> PERIOD 1 PERIOD2 PER D PER INCH <br /> P- / a78' None .5 / J 3 <br /> P- o? 078" None 5 a 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 ci aces. 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 bort 9s and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION 96• Sca/e /"= �/o e�cepf uihu no%>! <br /> y 9h wa y 70 <br /> mss' Q <br /> Pao� o ,f�ffo o{'.sid,�9 <br /> o Ba n9 <br /> Pa° <br /> B/ <br /> A/0p/o11rnQle% Vo aeras <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and on thods 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 COMPLETE ON: <br /> lx/ba' I /YJ X07, /9 <br /> ADDRESS: CERTIFICATION NUMBEF PHONE NUMBER(optional): <br /> 315173 -7=7P10 <br /> CST/S I G N>ATU�R/E: <br /> !��R// <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester, <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />