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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 7969 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) p _qqlq- - %117— <br /> LOCATION: ' SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDI VISION NAME: <br /> N la-/sw / /R Ilp E to I p c <br /> COUNTY: MAILING ADDRESS: <br /> CT• 1) <br /> USE DATES OBSERV TIONS MADE <br /> NO.BEDR : COMMERCIAL DESCRIPTION: PR FI NS: ATION TESTS: <br /> ❑Residence ? ❑New ,Replace <br /> RATING:S=Site suitable forsystom U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLOLDING TANK:RECOMMENDED SYSTEM:loptional) <br /> S ❑U S U 0SEA S ❑U S ❑U o 0 <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.091511b1,indicate: �r Floodplain, indicate Floodplain elevation: Np <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALPTH TO GR O DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, E LEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 kL `91.1 NONE (p 3 II -%B1M s S 13oms G3- 6 NPu w cm <br /> B-2 $0 3.5 NONE ? `30 ()-/151M 1- 'dams <br /> B- 3 �Z $1. 7 lJONE (off o-'I$Ims - rc� msW cm mo <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER HOLE TESTTIME DROP IN WATER L V L-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. pERIOD1 PERIOD 2 PERIOD 3 PERINCH <br /> P- I 7D Nos /` R L 3 <br /> P- Z y N b � r v 3 <br /> P- /'6 b A L <br /> P- <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of Percolation tests, soil b_orin s and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- <br /> zontal and vertical elevation reference points and shJa pi-thttif to tion on the plot plan. Show the surface elevation at all borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION �0 <br /> -- , T- -ry <br /> ;fill LPT UNC. 7_foa <br /> _ IVCK <br /> S G <br /> 2o7e <br /> I <br /> i 6 <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 Jata recorded and the location of the tests are correct to the best of my knowledge and lief. <br /> oa, l/1 <br /> NAME (print l: TESTS WERE COMPLETED ON: <br /> Ic RR o NS 4 - 2-0 - 94 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBE loptionall: <br /> 2—?-76o 3S WF-F> EK tjj . S`�S93 o - - IS <br /> t CS=E: <br /> DISTRIBUTION; Original and on copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — d- <br />