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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR ANDP.O. BOX 7969 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP)MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> w '/45W '/, 6 J-56N/R (a (or)W WOOD zlv-ep !v/k <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> 91-//2/VGT/ AUC An/OEYLSa✓ 13oX /87 NEW /j/c#Afi A/t $¢017 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PR FILED RIPTIONS: ER OLATION TESTS: <br /> Residence N New ❑Replace <br /> /z11Z 9z-- NIA <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUND-0f-iI S I III : SYSTEM-IN-FILL HOLDING TANK:RECOMMENDED SVSTEM:(optional) <br /> ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U y <br /> If Percolation Tests are NOT required DESIGN RATE: I If any y portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: /V/,[F Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, OBSERVED EST.HIHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 7Z /oo, O /voivE 7 7Z• 3" gz_Acr 5 r Co <br /> B- <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS N/,¢ <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODt pERIoo2 p R 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 /> SYSTEM ELEVATION 97,0 ' 716 loo, O ' <br /> _F cry o' <br /> T <br /> JL. yecpaSEZ�, W&JL_ O s6 <br /> 3 //¢,0 <br /> ¢, <br /> �I L?cRTle^/ eg�`or <br /> 2 - <br /> O <br /> ABEA/CF/: ro" /VA[c /!V /-S"„ <br /> sTu�P _ <br /> ASS/i/MGO Ec c-✓',47109/ 9' <br /> t <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with thee <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best o�k\n6wledgege and belied methods specified in the Wisconsin <br /> f. <br /> NAME(printl: TESTS WERE COMPLETED ON: <br /> TNorv/gs t t _S'WCi✓Son� OEc. <br /> ADDRESS: <br /> CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> Z4-7 96 57-wrar ,ems ss S/°ecAj S4�7Z z/ s3 71S 3¢9 zS93 <br /> CST SIGNATURE: / <br /> �i <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. - <br /> DILHR-SBD�6395 (R. 10/83) —OVER — .� <br />