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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND, PERCOLATION TESTS (1151 P.O. BOX 7969 <br /> HUMAN RELATIONS \ / MADISON,WI 53707 <br /> py' (o (ILHR 83.0911) & Chapter 145) <br /> L ATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> '� '/+ S11 N/R16 E (p W I WE ART OSm V q <br /> COUNTY: MAILI GADDRESS: <br /> E Tim C.n sE 3 1 <br /> USE . ST.P111ALMn .5SQ75 <br /> DATES OBSERVATIONS MAD <br /> NO.BEDRMS.: COMMER AL DESCRIPTION: PROFILE DESC S: A ESTS: <br /> ❑Residence •-7 �� ED New Replace (T II q� 5- II- n3 <br /> RATING:civ S=Site suitable for system U=Site unsuitable for system O I -IJ <br /> Q_..,�TI❑� M. fV�. ❑� IN- ROUND XS �ESSl1RE:S STEM-I N❑-FILL O❑LptNG TANK:RECOOMMENE D SVSTEM:(�tional) <br /> S NQ <br /> If Percolation Tests are NOT required DESIGN RATE: I If an <br /> y portion the tested area is the iq <br /> uncle, �- Il er s. ILHR 83.0915)161,indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL PTH T GR UNDWATER-INCHES CHARACTER OF SDIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED E HIGHESTTO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- I I`1.9 Non/E > `l$ o- faBlms <br /> B-2 �� 6.5 oNE lab o-`t Blms 1 -�� Nrru <br /> El--3 8 II$ .OIVOIV6 '700 b-'►Blurs -'183�1ms <br /> B- <br /> e- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP I WA ER LEV L-IN HES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. pE RI ODt P I D2 PER INCH <br /> P. o b is �fc 3 <br /> P- Z t� <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 X14. 9 <br /> TI <br /> T r <br /> * I <br /> „} + DF Ul► r2 <br /> w o <br /> � 2)i(o8 <br /> LbT -4 <br /> T ? <br /> tN <br /> .�, <br /> �.:IEII <br /> � � b <br /> 3 ' <br /> I,the undersigned, hereby certify that the soil tests reported on this form were ade by me accord with the procedures and mer ods s ecifCied in e///'Wii consin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to a be of my k o edge and bel ief�S_ �H Sp <br /> NAME (print): <br /> rV;TZWERE COMPLETED ON: I <br /> IC H 19 P,D 14 0,0k I 06 - H - 93 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> w 35- WEa ) ) . 893 3670 IS <br /> CST SIG TURE: <br /> vy<,v7 <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHRSBD-6395 (R. 10/83) —OVER — <br />