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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 LOT NO.:BLK.NO.: SUED VISION NAME: <br /> )V 1,.y 1/-sE 1/a `7 /TON/R I,6 E lor)W v 4 /l o J AI JS �-e r, o o s <br /> C�jUNTY: ,.y.} OWNER'S BUYER'S NAME: MAILING ADDRESS: y <br /> 1 °tnnlc Il ^L 4 '-• ' t4S0 tils BO /J� � Jr/i11c /� Y dl h� SS- 0 37 <br /> USE DATES O ERVATIO S MADE <br /> NO.BEDRMS.: COMM ERCIAL DESCRIPTION: PROFILED CRIPTI NS: PER OLATION TESTS: <br /> (Residence �L_ r/ ) New ❑Replace _ G,_ (/_ '9_8 JT <br /> RATING:S=Site suitable for system U=Site unsuitable for system 7 <br /> CONVENTIONAL: MOUND: IN-GROUN6PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM (optional) <br /> ®S A ©S ❑U [ZS []U ❑S ©U ❑S DU Co j <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)16),indicate: 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 EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> B- 1 N n 10 0.5- o IJ-e > 0-e„ B Ar /I, Y !s 6 „ to <br /> 0— 0 > 80 '/ e �s <br /> tl p <br /> B- s -7 q9' � I I <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERI0D1 PERIOD P RI D j PERINCH <br /> P- I 2Z N o s 3i8 a7' a � <br /> P- <br /> P- <br /> P_ <br /> - may' <br /> P- a l <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 borihigs and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION <br /> Iles > 30D' + <br /> SIDG � <br /> TN <br /> sbAc15 III= q0 I� � •Q' ". y�l�ow <br /> ♦ M1 yI vat_ <br /> • Af 2 s <br /> D ?r,4eG n <br /> WE 11 To BF. 31l`Ra mt9 FA°IM SdiG A65aP�T/dlU S_4S7PM Lot L is <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by mein accord with the procedures and m thods 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 COMPLETE ON: <br /> IL ar o19-9 - 28 <br /> ADDRESS: CERTIFICATION NUMPHONE NUMBER(optional): <br /> Wk 5 3670 I 66- l <br /> CS SIG IATURE: <br /> rs <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester, H <br /> DILHR-SBD-6395 IR. 10/83) —OVER — <br />