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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, _ C BOX 76 <br /> DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS �y <br /> (ILHR 83.09(11 & Chapter 145) �,/—��('"/,5 <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> 1J� 4 ,�y /T N/R E (or)W S W15-5 3 q N <br /> COUNTY: OWNER'S BUYER'S NAME: MAILINGADDRESS: <br /> u 7 THDRAS D ANUS W 15ND <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: PROF LE DES R IONS: ER LATION TESTS: <br /> �Aesidence 2 �� New ❑Replace I��'��00 <br /> RATING:S=Site suitable for system U=Site unsuitable for system 00 <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> 0S ❑U ZS ❑U Ks ❑U ❑S .®U ❑S ®U CoNJ <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: L I I Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 $5 / 00.S- NONE > 485 O-6 8151 ( -Ss BN M5 <br /> B- 7- ID0. 5 tjotic: > �S ©-� �I51 - BS"BNrns <br /> B_3 `�S </ NONr; > g' <br /> B- `f $5 IDs', a - n1on ?$S JIS) 6" $S to M5 <br /> B- 5 /0 �, 9 IJONE 7 `�� (�=1 7$s aN n15 <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. PERIOD PERIOD PERIOD PER INCH <br /> P- <br /> P- 13 <br /> P- 3 ?Z1 <br /> s <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 v d RPP �6�01► o A/c iN/o"Qed oAk <br /> � BOKE <br /> Q <br /> l �1J�u�J6gM� <br /> > 20 [ K <br /> TN <br /> N <br /> q <br /> � J <br /> F• lto' — � <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): IS TESTS WERE COMPLETED ON: <br /> 57�ADDRESS: C ERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> GcJL�s7 CJI y89 36']a `ql' <br /> USy 1U ATUR E: <br /> DISTRIBUTION:_Original and one copy to Local Authority,Property Owner and Soil Tester. (-,(,✓N�[.v(� I <br /> DILHR-SBD-6395 (R. 10/83) —OVER — !/ <br />