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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS 1115) P.O. BOX 7969 <br /> 3707 <br /> HUMAN RELATIONS' 1 / MADISON,WI 53707 <br /> (ILHR 83.090) & Chapter 145) <br /> LOCATION: SECTION: /�TOWNSHIP/MUNICIPALITY: OTNO.:BUK_�O.: SUBDI VISION NAME: <br /> W�� NE �V4 33 /TLIoN/R Ib E (or� OA i_ Z NA 2- <br /> COUNTY: <br /> COUNTY: MAILING ADDRESS'. <br /> R o S N WCWrf; wl 54893 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: I A TIES S: <br /> ®Residence ? ❑New ❑Replace <br /> RATING: S=Site suitable for system U=Site unsuitable for system b D <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ®S DU ®S DU ®S DU OS ®U OS ®U <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: 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 E T TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- ! 72 °99•S NONE >'72 0- 181m ` -5y5Nnu 5` -97W <br /> B- <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> } EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD P Rj PERINCH <br /> P- <br /> P- <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 i <br /> - -- { _ <br /> $TOMS_6FTTF R?_ . <br /> GqK� <br /> VENT <br /> •wen <br /> _ a _ TRlue <br /> SCR4E I„;SD' , <br /> -� SM ioo%oi COF -III- - <br /> FIRe is 273 78 <br /> 1, 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 ITESTS WERE COMPLETED ON: <br /> XICHAKD HOPKINS 11 - 15 - SS_ <br /> ADDRESS: CERTIFICATION NUMBER IPHONE NUMBER(optional): <br /> 6-R wil _T46T3 3470 r715 - &4 - <br /> CST SIGNATURE: <br /> DISTRIBUTION: Ongmal and one copy to Local Authority,Property Owner and Soil Tester. L� <br /> DILHR-SBDb395 IF. 10/83) — OVER — <br />