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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN-RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: <br /> : OT NO.:BLK NO. <br /> : SU <br /> BDIVISION NAME: <br /> t4 W�/d I/ E (or b Ni <br /> COUNTY: MAIILIN ADDRESS <br /> 060k#67 JO ) ZZ 5M 445 All <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: T <br /> Residence 27 �� New ❑Replace 9 - �7- <br /> RATING:S=Site suitable for system U=Site unsuitable for system C� D / <br /> CMS EJU . "�. ❑U IN-GROUND-PRESSURE:❑URE: SV❑� I�UL OLDI O� �]I U .RE{�NYENTIOAN MENDED SYSTEM:(optional) <br /> DESIGN RATE:: <br /> It Percolation Tests are NOT required DIf 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 GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED HET TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B 1 /2 O.2 N RE -77z- 'go(l5 <br /> B- 2 72 2g.6 t�ouE 77- <br /> B- 3 1 '?2- 97. 7 E 77Z - -1ZBNms <br /> B- 4 ?2 q7, 3 0 ;77z 0 - ?z BN ms <br /> IB- 6- Z 17- Z A10"c" 772— 0 • ?7- 511m5 <br /> B- <br /> PERCOLATION TESTS <br /> CTEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHESRATE <br /> INCHES <br /> F NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RIOD1 P RI D P <br /> P. ! O S / /s A Z <br /> p- Z O s y Y ' c Z <br /> P- NO S 3 3 P1E+ 2- <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. S _ <br /> i <br /> � O <br /> L9G ( ( <br /> 1 <br /> , I <br /> -i i ss1111TTT""" i , <br /> I <br /> ScFa_Ir07E.DBM 100 OIL*FOOCKTMIlE <br /> I <br /> d fac -- <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 /> FIC14 LI�9 o ki,- _ _ - - <br /> ADDRESS: CERTIFICATION NUMBER:TPHONE NUMBER(optional): <br /> cvEasr s <br /> '3670 1715-&6- <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. � <br /> DILHR-SBD-6395 (R. 10/83) - OVER - i <br />