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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, - - DIVISION <br /> LABQ <br /> HUMAN <br /> MADISON,AND - PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN RELATIONS SON,WI 537073707 <br /> (ILHR 83.09(1) & Chapter 145) <br /> OCATION: SECIIION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.Ndj SUBDIVISION NAME: <br /> �'/ ✓ '/a �5� N/RJB IorIW F� o NV1 Nn Pic <br /> COUNTY: OWN�WS BUYER'S NAME: MAILING ADDRESS: <br /> WK �Rrt 2 O (�E651-p-/Z W I <br /> USE DATES OBSE RVATION S MADE <br /> NO.BEDRMS.: COMM ERCIA L D ESCRI PTI ON: �y PR FILED UUU TIONS: PE O ATION TESTS: <br /> Residence '3 /\ / uNew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuiittable for system <br /> C NVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FI LL HOLDING TANK:RECOMMENDED SYSTEM (optional) <br /> S OU S ❑U S DU OS ®U OS U <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. Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COL R, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON CK.) <br /> B- / '3q. 7 NDn� > Bo 0- 8o R ►ns <br /> B- 2 <br /> 13- 3 51 HR5 BEEN uT <br /> B- � h <br /> 9y. y <br /> II II <br /> e- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER CHES AFTERSWELLING INTERVAL-MIN. P RIOD1 PERIOD P R PERINCH <br /> P- rjo 1,711. Iii 3 <br /> P- .2 RID -y 3 <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 distar ces. 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 borini s and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION 93 <br /> s ^1 Isct Pat,a*rn Pokc �4sc <br /> scQCc I ' '� —I or <br /> H.n Cess NSfti � � �t'v `? <br /> � 3 <br /> �. ?N <br /> /Q4-er 300 ' /orAk <br /> D � <br /> ►7w' �0fik1Itl e4�7 84f 3!T� <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and me ods specified in the Wis onsin <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 N: <br /> Fri t rti G f <br /> / � <br /> AD RESS: CERTIFICAT ON NUMBER: PHONE NU BER(optionaW <br /> LIS ,- Ll 3 7 <br /> CS NA URE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) OVER — <br />