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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 /> P.O. BOX 796 <br /> HUMAN RELATIONS / <br /> (ILHR 83.09(1) & Chapter 145) (al - - s Z <br /> L ATI N: '/ SECTION N/R �• 10 ) TOWNSHIP/MUNICIPALITY: LOT NO.: LK.NO.: SUBDI VISION NAME: <br /> 1 14 <br /> COUNTY: MAILING ADDRESS: <br /> 31(grxIT ffwr PECx_ 9 E iSr I q <br /> USE DATES OBSERVATIONS ADE <br /> FtNO. IAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TE <br /> .dance <br /> STS: <br /> ❑New Replace <br /> RATING:S=Site suitable for <br /> rrrssystem U=Site unsuitable for system <br /> O❑�TI�U MILVJ ❑U IN-GROUND ❑U E: SV®S I❑ULH❑JG®U .RECO MENDED I/VGl1DL.INV SYSTEM:I�tn'ai T,IAfS� <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the /S <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED ES HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 66 NONE- .59 ( � 'SY18l�rns ScI - (Av N s wRcm d1t <br /> B- 2 5 q�{ (� NE o 181 : 1 - SaBd s SD SllBa�s w RcmdmoCt <br /> D- 0181 s Cl -(008114f5 6o-GG N SW9CrrAMj <br /> s-3 6(o qS.N' only b0 <br /> B- <br /> B- <br /> B- <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 1 PERI D2 PERIOD 3 PERINCH <br /> P- 1 7-3 to s 4c Ir <br /> P- 2 1 7 3 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 93.5 <br /> R oVbo <br /> ' 1 <br /> L/ I <br /> ��►`� ,I��w Ww�, To BE. >:�f�a►-too._ i _ <br /> I-A KE . fiw* <br /> A <br /> A ; <br /> 091)9En 1 <br /> , <br /> l I <br /> 1,the uncle igned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures nd mRLhods specified in the Wisconsin <br /> Administra ve Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and be' ([l,J{`A'� ,S�_ <br /> y� ' <br /> NAME (print : TESTS WERE COMPLETED ON: )IV IWf 1_7 <br /> - 3 r <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 'L�760 5 r85?ER i. S 3(0 D I - 6- 5 <br /> CST IGNATURE: <br /> / <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> OILHR-SBD-8395(R. 10/83) —OVER — <br />