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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> DIVISION <br /> INDUSTRY, - <br /> LABOR AND PERCOLATION TESTS (115) MADISON BOX <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/ LOT NO.:BLK. SUBDI VI ION NAME: <br /> s��44NI/ ,s/T46N/RistlorlW S � 4a ^ t<�f . <br /> COUNTY: OWNER'SBU.i'.^.-'s...,::nE: MAILINGAHESS: <br /> J44r`&, e7�-f. � 4rn 6T ✓ D/ ;r IW .r <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: a PROFI LE DQESCRIPTI NS: PER OLATION TESTS: <br /> Residence ❑New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system P <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FI LL HOLDING—TANK: RECOMMENDED SYSTEM (optional) <br /> EIS ❑U EIS ❑U ❑S ❑U ❑S ❑U ❑S ❑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 I Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> B- <br /> > 12 0 s'et? a0 " crA?W " nwrol <br /> B- <br /> B- <br /> 13- <br /> 13- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PE RIODI PER1002 PERIOD PERINCH <br /> P- <br /> P- <br /> P- <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 dist nces. 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 bori gs and the direction and percent <br /> of land slope. <br /> S TEM ELEVATION a o•< <br /> i,^ycf�`t LQ <br /> 100 <br /> a <br /> a ra� tl TN <br /> �4t , <br /> e <br /> H <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(prJi70 , TESTS WERE COMP ET DON: <br /> R� "WH1C 0 rHS F <br /> ADDRESS: CERTIFICA UMBER: PHONE NUMBER(optional)- <br /> 71- f66 - Y«7 <br /> CS GN TUBE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> D I LH R-SBD-6395 (R. 10/83) —OVER — <br />