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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> DIVISION <br /> INDUSTRY, <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/ Y: LOT N0.'.BLK.NO. SUBDIVISION NAME: <br /> N '/ay /T10N/R/SV(or)W J_vC_/i-sr4) u14 ,V IVA <br /> C UNITY OWN R'S BUYER'S NAME: }, MAILING ADDRESS: p 1 ,3's' SS <br /> WT t- Ili !oQ/S' Mvc /J-P �/^ Cf 1' ( J0R yr /vl <br /> USE op DATES OBSERVATIONS MADE <br /> NO. RMS.: COMMERCIAL DESCRIPTION: I�� IPRO � DE CRIPTIONS: PE jLAT�N�TESTS: <br /> Residence rp New ❑Replace Op 3 7 GG 7 <br /> —' ��—/ <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 /> Q�JS ❑U �S OU ®S ❑U ❑S ®U ❑S CSU e o ,uv <br /> DESIGN RATE: <br /> If Percolation Tests are NOT required If any portion of the tested area is in the <br /> under s. ILHR 83.091511 b),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.HIGHEST TO BEDROCK IF OBSERV DIS E AB'I V.ON BACK.) <br /> 0 -7" 84. < n SC at - 0 <br /> B <br /> 9s o � MotJ� � � �6 '= �r s <br /> 0-7 ^ 16 s 7': a3" ASL A3 • 70- A4@ 611 <br /> B- 6 Ll' I <br /> L4 8 B<< t It' aS" 'ems C 9S f'. 75 F'rw' 'P <br /> B-/-/ 7S- of)r9 11 > ;;15— <br /> B s g cors [ I � � Q-7'L` � Ir -7'. ar,'e„ ss- <br /> El- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD P RI D PERINCH <br /> P- r S-1 l po <br /> P- / F rV0 / 0 s 3 / <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 ! © A t AReA �L/ F • <br /> S'c <br /> �4AIN <br /> IP-ed <br /> r� ►�t !d o <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 (prin TESTS WER3 7 �E PL MT ON <br /> P1e : <br /> tj rre � U 7f Ins <br /> ADDRESS y� CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> Cl Qf3 4 x'66-yi5 <br /> C GN TURE <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/63) —OVER — <br />