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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 /> (I LHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/ftfttfiPAL117: LOT NO.:BLK.NO.: SNAME: <br /> 5E '/ E '/ a3 !T NlIV46E ( r) UBDIVISION <br /> COUNTY: OWNER'S AILING ADDRESS: <br /> UR / <br /> USE DATES OBSERVATIONS MAD <br /> NO.BEDRMS.: COMMERCIA�DESCRIPTION: Pp.OFILlD �IPTIONS: PER OL�T ON TESTS: <br /> Residence 3 " 1//� ❑New Replace I 3 dA 7 <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUND-PR URE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ❑S XU ❑S xv ❑S ❑S ®a I ID'S ❑U 11MAJ/ 87 7)W a" t. <br /> If Percolation Tests are NOT required OESIGN RATE: If any portion of the tested area is in the �� <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: 4 <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) <br /> B- r�,y 0o� �y �� S „ " S &,1A-( <br /> B- I b / <br /> B- <br /> B- <br /> B- 9923= <br /> PERCOLATION TEST <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP INW EVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AF ERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 3 PER INCH <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. ,n,ll <br /> SYSTEM ELEVATION *4 <br /> SWAMP a- LaWLAQ <br /> too .�RrvE <br /> A B� plld 0 Aly 8orrm4 of <br /> $ /nrG Al C'dP�LER of <br /> ¢/OUSE EL - 1W TN <br /> � 1 <br /> � t(aUse y Q SoY� /J1�G.S <br /> k'�tc <br /> /"4kt. <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 WERCOMFLETED ON: <br /> ADDRESS: CERTIFILIATION NUMBER: PHONE VJUMBER(optional): <br /> Bs liJ C! T <br /> CST SI GN T RE -- <br /> L/�E <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />