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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, - _. DIVISION <br /> LABOR AND P.O. BOX 7969 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 53707 <br /> (I LHR 83.09(1) &Chapter 145) <br /> LOCATION: : SECTION: TOWNSHIP/ 4ttYf: LOT N0_T1 IG.CIO.: SUBDIVISION NAME: <br /> ldk:1/b/� 1/ 3a /Tx1aN/R»E (p ,voA a oOJ-AKEE51A <br /> COUNTY: OWNER'S BNMER'SM/eME: MAILING AD DRESS: p_ y/�a_ayay Al- a/7'x_'A0n70 <br /> 06",/)67 T 40, E Tt-'v smI Box G V <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMMERCIAL DESCRIPTION: �� (PROFILE DE :1 IM PER OLATION TESTS: <br /> Residence ^{ //Q New ❑Replace �//C� <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SM-I YSTEIFILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> Mrs ❑U ds ❑U ms ❑U I ❑S 20 1 ❑S A e'oVt'! BED /yir3 ' <br /> DESIGN RATE: <br /> If Percolation Tests are NOT required 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 EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- J <br /> B 3 $3 /o/. �'' �/� 7P " 809/7 Swh� mon <br /> B- <br /> B- ? r . �a c / 7 M 5 Ile 9" A5 <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. PERIOD ( ____PERI0D 2 PER PER INCH <br /> P- A16 <br /> P- d 3 All"I'19 /,;;; 3 <br /> P_ 3V Ak,Al L5 <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 I� <br /> EAsvnrEM„TO iI - <br /> 1""'--1P.��,g��fyR' d be'✓ I 7EWIE5 • e,4 - IGF of %'K'cp <br /> pdP Pg <br /> g e? <br /> I i ROAD q/pl Cc-Wfk F4 - /d¢ <br /> IV6 7-0 3S' 13 S614 6011"IA14-c' <br /> TN <br /> A Peke 7cs r s <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 COMP ETED ON: <br /> <rA) -S-1 if AiBl ��� l <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optionall: <br /> CSTSIGIgATURE: j <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />