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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION:� '/ SECTIO 11 /T y611�R/bE (00 TOWNIVMN 44A IT�Y: PNO.:BLN�O,: SGS IV�SIO�NAME: <br /> COUNTY: MAILING ADDRESS: �, <br /> 9 stfln<'t"f erg 5 T e T!t a joP 4 /3-4- le (.0-e j --, (.J <br /> USE IDATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: TESTS: <br /> Residence s u•1—U "Y-O Lt --C- ❑New ❑Replace I � „ d S-_ O 7 <br /> I 1SG <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDI NG TANK: RECOMMENDED SYSTEM:(optional) <br /> DS 0111 ❑S ❑U [:]S OU <br /> DS EA EIS ❑U I d4f Wt4,c.,R-c <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> Q 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, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- �� ( cam �T'Q 77 �7`r,BZ ( f 7 ., �„ rw� �c �c/ 9a :.f,P S <br /> B- <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> RTEST DEPTH I WATERIN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> i NUMBER INCHES- AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI D2 P R PER INCH <br /> P- <br /> P. <br /> P. <br /> P- <br /> P <br /> P_ <br /> PLOTPLAN: 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 <br /> n <br /> I <br /> TN <br /> _ o <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 /> NAM print): TESTS WERE COMPLETED ON: <br /> ADDRESS CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> C TUBE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395(R. 10/83) - OVER - <br />