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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, -. DIVISION <br /> LABOR AN4 PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (I LHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> -'1 W 1/ /T'f ON/R/5E (o C <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> 5UNC- ffS19" oAKR(Dr_-E-rRPLBLAwEMWSS 3 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: �,y� PROFILE DESCRIPTIONS: R O ATION TESTS: <br /> Residence ''1 KNew El Replace <br /> „ Q -,�Q <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: �IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RE COMMENDED SYSTEM:(optional) <br /> ®$ ❑U N$ ❑u l :$ ❑0 ❑$ ill ❑$ � C.OtiVC_NTL 61 <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> dic <br /> under s. ILHR 83.09(5)(6),inate: lr­__ -- 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 I Z NotrE 72 0 5131Ms 5- 7 ti <br /> B-2 2 NE 772-- - S - 7 <br /> B-3 0 <br /> mop& m. - 72 <br /> B- `f Z 2 KtnJE 7Z -6 - <br /> B S72 S - NONE > 7Z - 6- s <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD 2 PERIOD3 PERPERINCH <br /> P 1/ I H. <br /> P- 2 ' 3/ <br /> P- i rr <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 <br /> �►8M1D0 j)qt/A �4o_';Ragk <br /> d yyTac <br /> .fl C7 <br /> .3 <br /> �j Alli TN <br /> IuC <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 it 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): /� 0 TESTS WERE COMPLETED ON: <br /> fth� <br /> ADDRESS: CER FICA ON NUMBER: PH N NUMBR(o <br /> W 5 3 o -U- S <br /> CS NA URE: <br /> 11 <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />