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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 83.09111 &Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: 51899hb461AALf4kh1£+: <br /> E�/ �/ /T VN/R/6 E (or 0 C p 2 1 AA <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> JA 'Dixo o - S <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: k' PROFILEDESCRIPTIO PERCOLATION TESTS: <br /> Residence Zi ^ XNew ❑Replace I <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FI LLHO LDI NG TANK: RECOMMENDED SYSTEM:(optional) <br /> S ❑U SIS ❑U NS ❑U ❑S ®U ❑S ®U I COUeNTIONAL_ <br /> uired DESIGN RATE: <br /> Q If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> If Percolation Tests are NOT re <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. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) <br /> B- 1 72 971 o 6 > 72 0-5B11;r5 s-36 BNms %- 77- acs <br /> 13- 2- it '770 f D-S S- / yrs `f/- 77-Rc5 <br /> B-35 " _ 11 &urns qy - 7z/3Ncs <br /> B- a q g m 8 ms 3s- 77— <br /> B- 5 /J <br /> 13- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERI0D1 PERIOD P R PERINCH <br /> P- I D S /'-1/- / 3 <br /> P- 2— I 0 S Z 3/c <br /> P- 3 7-1 No 5 2 3i 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 95.5 <br /> I <br /> �o�INsal� t ) s <br /> 4 <br /> I <br /> MOMP ,3 o <br /> - IN <br /> S - <br /> CAI.ti ("=9d Vk)Lfy, N0[ 'DR�vE `� <br /> ♦$h11oo NAI�iN'�rrR�' <br /> I <br /> wF1L (oaE > So MTA 501TO&C <br /> R <br /> Aft7' G/FT PUMP ? vIR655 AMox 9 kl r 7D1A'_ <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 /> I Al - — q <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> CJI sqsq3 3670 - U6- L115 <br /> CST�IGs ATURE: -... <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DI LHR-SBD-6395 (R. 10/83) —OVER — <br />