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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 /> HUMAN RELATIONS ' <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: OWNSFjJP/� OT 1\10 BLK.NO.: SUBDIVISION NAME: <br /> '/41/ �3 /T-�N/RIVE I.& //G,�� 5/r� C/o% ✓� �?�5 <br /> COUNTY: JMAILING ADDRESS. <br /> CcrhtCl ' 00 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: PROFILE DESCRIPTIONS: A I TESTS: <br /> %Residence - New ❑Replace /7-)�jy w <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONNVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:Ioytio nal) <br /> W$ ❑u W$ ❑u Z$ ❑II EIS ZU EIS (N(Ifl)L_)17?/ <br /> E <br /> A <br /> IGN RT : <br /> If Percolation Tests are NOT required DESIf any portion of the tested area is in the <br /> under s. ILHR 83.0915)161,indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL P H TO ROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEV(A;TION OBSERVED E TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- / �� o6. /Z�O/Je � 7 DlO"DE n /s,l�"- <br /> B- ;Z� k 9� 7 <br /> , <br /> 5'DE Bn 1.5, /-5;0;5"- 7a" mro s <br /> > 7 SQrne G� B <br /> 13- <br /> PERCOLATION TESTS <br /> EST DEPTH I WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> 1' NUMBER INCHESI AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RIOD2 P R PERINCH <br /> P_ l CYC <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 JDiro ifv o/ lt/ C noIed <br /> A <br /> ICA 3S' <br /> PoA.6_3 /�f�,D/D limey L3 /�5C� <br /> d <br /> V <br /> �3 ' <br /> F . _ . . . v _ <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) TESTS WERE COMPLETED ON: <br /> y 990 <br /> ADDRESS CERTIFIC ION NUMBER: PHONE NUMBER Ioptionall: <br /> CST SIGNAj UR 0 <br /> ..J/J <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBUG395 (R. 10/83) —OVER — <br />