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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, C DIVISION <br /> BOX 796 <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK NO.: SUBD VISION NAME: <br /> M 1/S W 1/ 1 1Tqj2N1R6E (o'6V 06aAliD 1316 / OA <br /> COUNTY: r/Ic MAILI,` � y <br /> NADDRE�SS: <br /> SCA5 S N <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMM R IAL DES RIPTION: TS: <br /> Residence �2_ 1� XNew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system J OO b J <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> S ❑U ®S ❑U ®S ❑U ❑S U ❑SRA co�u- <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: (_� i Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,CO OR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> B- 1 72 1 q$ 3 kooj5 >72- <br /> B- <br /> 72B- 9S. (0 WE ` ©-6 b - Z s -72-3N M5 <br /> B- 3 n $ 4 NONE I1 0_(D S LZ01MS '2 - 72 )") ms <br /> B- q 9<6 2 ivoau - AMf- A5 13-3 <br /> B-JT " 6 AouB II o - s G- 3531!s -g213N ms <br /> B- <br /> PERCOLATION TESTS <br /> C DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATTER INCHES <br /> F NUMBER INCHES AFTERSWELLING INTERVAL-MIN. —PERIOD1 P RI D <br /> P- I ,vo % y 3 <br /> P- 2 2(. 3 /%& L 3 <br /> P- <br /> P_ <br /> P_ <br /> P_ <br /> PLOT <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 bor ngs and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION �6.3 <br /> ;WEST <br /> SGRLf- 'I°='tOr,t7Nt.55 MoTE.D <br /> ABM too iJAtl to 18111t-P OR _ <br /> WErITo BC >Sb'Atr?A� �RoPass� VR%V� . �N <br /> FRS SUITAg�� HKMA BIDE _ _ <br /> I <br /> 4 t 2 <br /> o A <br /> -P APj LOT LINE <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 ERE COMPLETE D ON: <br /> 7ZI cHpRo Wkips � - 5 - s <br /> ADDRESS: CERTIFICATION NUMB R: P ONE NUMBER(optional): <br /> t vE 2 wl 5`f 81� 3670 I 66- IS <br /> CST IgNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHRSBCI6395 (R. 10/83) —OVER <br />