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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 /> MADISON, <br /> HUMAN RELATIONS SON,W153707 <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP Y: LOT NO.:BLK.NO.: SUBD VISION NAME: <br /> �'/ �uw�/a aS /TjoN/R/Sfor)W ctC IIIe A/ NA N <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> 4� e we /fiGan a cu >° 63T wil <br /> USE or DATES OBSERVATIONS MADE <br /> NO.BEDRNIS: COMM ERCIAL DESCRIPTION: PROFILE ESCR PTI NS: PE O ATI NTESTS: <br /> ®Residence ,/ ❑New Replace / <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUNDPRESSI III E: SYSTEM-I I IILLHOLDI NG TANK: RECOMMENDED SYSTEM:(optional) <br /> 9$ E ®S ❑I) S ❑� [IS Nu ❑S ®II e 0 w IJ <br /> If Percolation Testsare NOT required DESIGN RATE: If any portion of the tested area is in the <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,CO OR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ARBRV.ON ACK.) <br /> P. <br /> B-� � 7 . It S O r �.rBNIML �S blr,all <br /> aB- I / .. v�Lt.� .�✓i <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. PER1001 PERIOD PERIOD PER INCH <br /> P- TY q <br /> P- <br /> *14 � i <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 bor ngs and the direction and percent <br /> of land slope, S—c. 4,4 .t-- <br /> SYSTEM ELEVATION P he <br /> f I�� -_4 Am 11 <br /> I s�Pr'C, <br /> ll e44CLe, <br /> 5 p ` 7­6G� 'r TN <br /> y,*)." MQ x <br /> 14 <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and nethods 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 ETE :ON: <br /> /?.J% Irf)v S !/ P <br /> ADDRESS: CERTIFICA ION UM R: PHONE NUMBER(optional): <br /> i a S �6 <br /> C N TU E: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />