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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 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> S4:1/ ,ow 1/4as /T3s N/R/B Jf(or)W 600 d ej d e-i, - - <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> QaPNG� /y-4.mA-s /0,. LnwS Kc a7 bs S /S Q A)45, 5 <br /> P Ssfo`f <br /> USE DATES OBSERVATIONS MADE <br /> NO,BEDRMS.: COMMERCIAL DESCRIPTION: r� IPROFIDESCRIPTIONS: PERCOLATION TESTS: <br /> Residence — ❑New LJ Replace L/D , (7._ <br /> RATING: S=Site suitable for system U=Site unsuitable for system O O O <br /> CONVENTIONAL: MOUNpD: IN_ -GRROODUNND-PRESSURE: SYSTEpM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> QS ❑U ES ❑U PS ❑U ❑$ ®U ❑% WQ1 GoN0tn17"jeNA j <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.0915)(6),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 N. ELEEVATION OBSERVED EST.HIGHEST—TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- air /9+5 Pn/ >7a// 0._6 0/ 6-7.2 !&/7 meds <br /> B- a 701 99,3 Nert5le 27.;? o- QI s 7-7aa� ��ds <br /> B 3 �d,a q9 y /1}orv1P 7 �.��� $v/rl t As 2 <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. PERIOD PERI002 PERIOD 3 PERINCH <br /> P- Na N 1 <br /> P-07 07 ar /')"M 4 S ! <br /> P--3 619 0V vN <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,--5- Ale— S-li cJG v� <br /> /do*tel <br /> wdm <br /> • <br /> 'Sl <br /> � otiw�rlo <br /> pa g LA.Ke <br /> TN <br /> 463 <br /> o P3 <br /> O pert <br /> !Sm /do /y`/ ,1 �• <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)'. ITESTS WERE COMPLETED ON: <br /> W a. al C u FS/lo/n'1 /o - 8 $_Q <br /> ADDRESS: CERTI FICATION NUMBER: PHONE NUMBER(optional): <br /> ,Bcy dJ G:J.r 358 3 866- 2;2 r6 <br /> CST A`TU/R E: <br /> Z�L n <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />