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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 /> (ILHR 83.09(1) & Chapter 145) <br /> LQQQ1/ tr / SECS 0%T u/V r to TOWO _ �� OT O.: / .: SUBDIVISION NAME: U� nl <br /> CO NTY: •'tJA �J 1 R L MAILING ADDRESS <br /> T Cy,/ I/U�, .�O/ Y <br /> n '6/jn� Aiiru/u Z_. ��h S�iccf �i mer Gree f(°i hf�, /ril <br /> USE DATES OBSERVATIONS MADE <br /> % NO.BEDRMS.: COMM ER IAL DESCRIPTION: /� : A TESTS: <br /> Residence ❑New ❑Replace e� ? /J/:n <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLOLDI NG TANK: RECOMMENDED SYSTEM:(optional) <br /> EIS ❑U I EIS ❑U I EIS ❑U I EIS ❑U IHEIS ❑U <br /> If Percolation Testsare NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: I I I 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.HIGHffST_ TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- > 7z" <br /> B- <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> ,C EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> T NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RIDDt PERI D2 P R PER INCH <br /> P- <br /> 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 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 /> I <br /> � <br /> ; <br /> a <br /> I , <br /> N <br /> n (see A&t � 4p _"#-j <br /> #-j <br /> I <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): ITESTS WERE COMPLETED ON: <br /> 1-I /ivLm C 3l 9 D <br /> ADDR SS'. CERTIFICATION NUMBER: P ONE NUMBER(optional): <br /> 2z 169 ( /� TIFff <br /> 2- CST SIGNATURE: <br /> Com/aor� <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Sail Tester. <br /> DILHR-SBD-6395 (R. 10/83) — OVER — <br />