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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, - DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> 3707 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (ILHR 83.09(1) & Chapter 145) :—�9— <br /> LOCATION: SECTION: ITOWNSHI PI1M UaNICIPALITY: LOT NO.:BLK. 0.: SUB VISION NAME: <br /> '/NEY 33 /T N/R/4 (Qr)w oA L/7ND <br /> COUNT OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> U ITZ E 'E 6i <br /> USE DATES OBSERVATIONSMADE <br /> NO.BEDRNIS.: COMMERCIAL DESCRIPTION: P FILEDESCRI T NS: PE//�qq� OLATION TESTS: <br /> Residence I []New Replace .— 2�-I - 8 7_ �f <br /> RATING:S=Site suitable for system U=Site unsuitable for system I V c <br /> CONVENTIONAL: MOUND: IN-GROUNID-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTE :(optional) <br /> MSOU MOO' 2S ❑U ❑S U EISMU DESIGN RATE: e-mvie lTIw L- <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 /> BORINGTOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, CO OR, TEXTURE, AND DEPTH <br /> NUMBER DEPrH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> B- 1 25 f02-. 2- lJome > g - 0- 7BIZ5 7'ZSBur�Ie�lsW 25- 85R��sw r <br /> B-2 11 /OI. 7 11 t 0- 881_3 8-30 BAIMdsW Y3 -SSRmed.5 W r <br /> B-3 f /02. I If 0-78Ls -28 BNntedsw r g'g�RM�lsw r <br /> B- <br /> B- <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. PERI0D1 PERIOD P R D PER INCH <br /> P Z 0 /0R9 <br /> 6 <br /> P- Z11 /0 Y b <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 toy�tL,r�+^pIa.�y. Show the surface elevation,a/t all borings and the direction and percent <br /> of land slope. W, F/-s S liA!C /y/�7U� '& W/7CKCN0W,9 <br /> SYSTEM ELEVATION ST <br /> T ��vlL.s <br /> 75 LA Ke <br /> N <br /> D, L±a56 <br /> �5 2Wtj <br /> NN <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 /> J��>� � a ,As - a 5/ - 87 <br /> ADDRES CERT( ICATION NUMBER: PHONE NUMBER(optional): <br /> L7t r w i _ SSP 8 3 �7 7is-866_YIS-7 <br /> CSyS1GNAT- URE: . <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. /vI�OIX/JRit2(j��(, <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />