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DEPARTMENT OF - REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, - DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> 3707 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOTN .:BI SUBDIVISION NAM <br /> I.E1/asu/1/4 7 /TVONAA/ ,Eto oal,1onl1 Tu/i2,1. — er 012,tj <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> rnef� <br /> USE DATES OBSERVATION:S MADE <br /> �[ 1Residence NO.BEDRMS.: COMM ERCIAL DESCRIPTION: 1,�/q N/ew ❑Replace PROFIL DESCRIPTI NS: PERCOLATION TESTS: <br /> L /IWIP <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONYENTIO❑NAL: MOL}ND:❑� IN-GRO{1S P❑�RE: SY❑STEM-IN-FILL HO❑LDINGU=J /Ow�� paSYSTEMha/ (optional) <br /> If Percolation Tests are NOT required DD ESIGN RATE: S U If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: I I Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,CO OR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVVAT'IO/N 'OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> B- 99 <br /> B 99 J /,U/O/Je a O-/O"A/:s X /O <br /> El-3 n 99 7 NO/7G > <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PE RIO 1 PERIOD2 PERIOD 3 PERINCH <br /> P. <br /> P- 8' �e <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 disti nces. 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 bori ugs and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVV 97. 17 ,SCa%e <br /> �o d ,fie/n9 <br /> 1N <br /> 6� <br /> 'da <br /> -` yelloul <br /> ftvar <br /> 1,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and n ethods 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 COMPLETE D ON: <br /> OK/e 161460117? qulw ,3, /9� <br /> ADDRESS: C RTIFICATION NUMBE PHONE NUMBER(optio nal): <br /> Cores /�� , u/t �/� (/7/0-) <br /> CST SIGNLyTURE:/ / <br /> 'RIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> SBD 6395 (R. 10/83) —OVER — <br />