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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 83.0911) & Chapter 145) OrL, l/ J(o 7CTfl <br /> L,,OCA-JION: / S�TIO%�� /�/�E1 1 TOWON�HMUNr IpALITV: LOT NO.:BLK.NO.: SUBD61VISJO�NAIWa <br /> C UNTY: yl MAI IINNGG ADDRESS: -V-,(. <br /> aG9s t►�t or /� 4 lYfN <br /> USE DATES OBSERVA IONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATIONTESTS: <br /> esidence 2 A I ❑New Replace I /� '1 �� /O r-�3�� <br /> RATING:S=Site suitable for system U=/Siete unsuitable for system l v �1 <br /> ONV ENTI❑� . [ S.�U IN-GROUND ❑U E: SVS❑TEM-INFILL HOOLDINGTArIK:RECO�on vSVSTEM:(optional) <br /> It Percolation Tests are NOT required DESIGN Ld{1 If any pfoorr9t�`tiifonn.of the tested area is in the <br /> under s. ILHR 83.0915)(b),indicate: Floodplain, indicate Floodplain elevation: ^/ <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPfH IN, ELEVATION OBSERVED I EgT—ATUH—EST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B-3 rn >66 <br /> B- Y 7 g=11" > 7 "l3ls ' 5 6 <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST <br /> DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUM ER INCHES AFTERSWELLING INTERVAL-MIN. p RI O1 PE OD2 PERIOD 3 PERINCH <br /> P- <br /> P S <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 5' c/ I! ! <br /> /lea � T <br /> as�m4d <br /> Row <br /> - CoQ' <br /> L BOY ! /40 Lot .... _ —_+ <br /> �s <br /> _ _5 � <br /> SCALA <br /> a _ , 1 N <br /> -rio well on :za- Z. rz <br /> ;t�3 _ ___ _ _ _ <br /> 50 ' >7�gl�bar �� ri <br /> Sy59�cm Si2G.._%5 /ak /b yon <br /> �4 war 7�, _« - <br /> 1,the undersigned, hereby certify that the soil tests reported this form were made by me in accord with the procedures a d d ecif ed in the <br /> W iWiscon in <br /> Administrative Code,and that the data recorded and the I tion of the tests are correct to the best of my knowledge and <br /> NAME (print): TESTS WHERE COMPLETED / <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> '357/ -PLOF 2166 <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 — <br />