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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY. DIVISION <br /> P.O. BOX 7969 <br /> LABOR AND PERCOLATION TESTS (115) <br /> HUMAN RELATIONS <br /> MADISON,WI 53707 <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/ C<P"LLIY: OTNO.:BLKNO.: SUBDIVISIONNAME: .Q/uei- <br /> '/ 1/4 /T N/WGA E (p — yo <br /> COUNTY: MAILING A DRES : <br /> Allfi- t /izi lo/ � Ifhlolel- '5freef- t_5f,�1//7x/ 55/oS� <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: �FTCE-DESCF A STS: <br /> ❑Residence ❑New ❑Replace I i�/�/./�/JD <br /> RATING: S=Site suitable for system U-Site unsuitable for system <br /> ONVEccNTI NA'IIL: MOUND: IN-GROUN1c1ESSURE: SVS EccM-IN-FILL OLDIINcNG TANK: RECOMMENDED SYSTEM:(optional) <br /> EIS EIV EIS Ou E]J FA EIS EJU EIS EJQ <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: I I Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEP <br /> TH <br /> IN. ELEVATION OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS - <br /> S -TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> f NUMBER INCHES AFTER SWELLING INTERVAL-MIN, PERIOD I p RI D2 p 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. <br /> SYS-TEM ELEVATIONa/e <br /> I I I <br /> J 4-1 <br /> tN <br /> -- <br /> i I _ <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 WERE COMPLETED ON: <br /> ADDRESS: C ERTIFICATION NUMBER: IPOONE NUMBER(optional): <br /> /G3 lc%b�fer i c/I � �%3 X583 S 7222 <br /> - <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> QIII4R.SRQ-6.1Q'; (R IQ/R_11 n co <br />