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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 576 X 3707 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1)&Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> r i �4 23 /T N/R b E (or IN ^ <br /> COUNTY: AILING ADDRESS: <br /> J t C 23`d I& 0!J R <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: R NS: ATION TESTS: <br /> ❑Residence 2 %New ❑Replace /) i]/f— nil 2_', , n2 <br /> RATING:S=Site suitable for system U=Site unsuitable for system �1 <br /> CONVENTION'A1L: IN-GRO ND-PHESSURE: SYS E(sM-IN-FILL OLDIINNGT K:RECOMMENDED SYSTEM:(optional) <br /> S ❑Ujr:S ❑U S ❑U S ❑U EISVU <br /> If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the <br /> under s. ILHR 83.0915)Ibl,indicate: IL Floodplain, indicate Floodplain elevation: Nw <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GR UN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED ES HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 72 9 U— ND m� > 72 0-5 131w S-7'ZSNms <br /> B 2 W 9T O NDNE > O-S SIMS S- oo BNms <br /> B_ 44 q9,0 NONIE > 114 Cy's Slms S- (o8 & s fol-85RIs <br /> 8--5 ON > (p0 o- la . 101s 'G- bo3Nnu <br /> B_ <br /> PERCOLATION TESTS <br /> FST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI D2 P RIOD3 PERINCH <br /> P- / 3 <br /> P- O No -5 7, i <br /> P- 9-13 <br /> 5 <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. $CALF <br /> SYSTEM ELEVATION 95. 3 /►f3tj 100 f4 AIL IN ?OWE2 PIDLE <br /> l L �0_h11�.501� <br /> tN <br /> 3 z QRoPobfm <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and method pati d jp thg`W sc n <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. St Y <br /> NAME (print): TESTS WERE COMPLETED ON: <br /> 91CPAK0 H017KIdS7 ` 2'J - Z- <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 2-l ') (o o Hvi 3 WtBSTi R w) . 5qSj3 ('7 0 1715 <br /> CST SIGNATURE: <br /> I <br /> i <br /> DISTRIBUTION: Original and one copy td Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBO-6395 (R. 10/83) �'I —OVER — <br />