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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> ULHR 83.09(1) &Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: S1iBfifVf9f9N'NSiIOfE: <br /> �_ 1/ 2.(o/T 1 N/RIS E (or)W w I 6.�.'f M <br /> COUNTY: MAILING ADDRESS: <br /> 1)R4E CH RL CS LODrR E 5303 BERCHS IOE DR. H/NNET 40 H4•553`43 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: NS: PERCOLATION TESTS; <br /> ❑Residence ^2 (� ❑ / ` <br /> New Replace I _ ID �'7 A _ to ��7 <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CO�/�TI❑� . MN! IN-G9 ❑� E: S�� 1❑t ❑�OLDINGZU RECOMMENDED C014VENTIMPL (optional) <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> Q ^ If any portion ofthe tested area is in the [� <br /> under s. ILHR 83.091511b1,indicate: ( ` Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED ES HET TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- I S0 8.3 I aWE. > U 0- G 81ms 6-SOBINi <br /> B-2 2 (o.$ N0P4E >7Z. 0- 731m3 '7- 72_ Fom5 <br /> B-3 $0 q$ .2 AONE > $0 D-G FIM 6-Vo$rims <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PIE OD PERIOD P PERINCH <br /> 2 / 3 <br /> P- 2 140 <br /> L 13i J <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 E ENATION �S I <br /> �_ <br /> ;?PVvy cel _I„, �o Uo"Now <br /> 7­1 <br /> 26' EKE A�RoK ba" *130N10051PT0`"]o SIDING <br /> >Zbo �nJr✓4l 7o t3ES4 { oNl <br /> BED <br /> i <br /> SIRE .� 59, <br /> IN <br /> I <br /> i <br /> 11- <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 /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> IN35 UI s IJI. 3y$93 3(a v IS-U, qLS2 <br /> CST GN TURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R, 10/83) —OVER — �' <br />