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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: SECTION: TOWNSHIP/MUNICIPALITY: OT O.:BLK NO.: SUB (VISION NAME: <br /> '/4 '/4 11 /T pN/R E to WD K�RAJ A/H Am <br /> COUNTY: MAILING ADDRESS: <br /> UQ ,6086 SL455QqoA) 01 MA) W I Sq9,30 <br /> USE DATES 46BSERVATIO IISMADE <br /> NO.BEDRMS.: COMMERCIAL DES RIPTION: A <br /> esidence �,___, ❑New ❑Replace n I _ 4 —7 — <br /> 17 <br /> RATING:S=Site suitable for system U=Site unsuitable for system •C. O <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSLIRE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTE :Ioptionall <br /> ❑S ❑U ❑S ❑U EIS ❑U EIS ❑U ❑S ❑U I 7'4 (I <br /> If Percolation Tests are NOT required DESIGN 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 GROUP DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,C LOR,TEXTURE,AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 77— '99. /)0,tA— > 7Z 0-4f5lms If-Ml?ms39ms <br /> B- <br /> B- <br /> B- <br /> B- <br /> e- <br /> PERCOLATION TESTS <br /> TEST DEPTH . WATER IN HOLE TEST TIME DR 1 WATER L V -I H RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p R1OD1 PERIOD 2 PERINCH <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 disl inces. 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 bor ngs and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION �- <br /> �E)Cs)sT106 ??toy <br /> Sc-ALE I" <br /> •3M IboBASE of l2"O wnriorm <br /> f ir�.tc 28I?5- <br /> vw11n5 <br /> LAKE <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and ff ethods 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 COMPLETE ON: <br /> I (49 00P16105 _ 61 - 2 ( - 3s <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> CST SI NAT/UURRE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHRSBDZ395(R. 10/83) — OVER — <br />