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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 JiELATIONS MADISON,WI 53707 <br /> (I LHR 83.09(1) &Chapter 145) J�7 �7— 7 <br /> LOCATION. ECTION:T TOWNSHIP/MUNICIPALITY: LOT NOBLK.NO. SUBDIVISI N—NAME: <br /> V <br /> or i'/ LLOO '/4 4( N/R/ ( S <br /> � — I a� zx9� yqq)e)I <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> USE ATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: �T PROFILE DRIPTIONS:1PERCOLATION TESTS: <br /> �Aesid� 11Yh1ew ❑Replace t� / r/ 5 ^l/__ <br /> RATING: S=Site suitable for system U=Site unsuitable for system / \, ✓ ' (v' l o`er O <br /> CONVENTIONAL: MOUND: II_J-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK:R ECOMM ENDED SYSTEM:(optional) <br /> �S ❑� l S ❑� XS ❑U ❑S SU ❑S tZU l� ur�r�l( Fi <br /> If Percolation Tests are NOT required f rDESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: N A— Floodplain,indicate Floodplain elevation: kON_� <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- f 00=Cf S � Ne-.5'L 75 /5ti . <br /> B wr46" gLILS (et �NrSs <br /> 5`` 3 L IL SL TS -7 5 ' <br /> B- � g� v t L �. <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD P R PERINCH <br /> P- <br /> P_ <br /> -P y <br /> P- N 1 <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 LE"TION (o (rte_ r <br /> i44& r <br /> ,tfNS f�cnb � Pam <br /> hI1D <br /> lot � <br /> ITN--2 00'-d - �—P���wrtC <br /> TowU R!7 <br /> ryryjj�� 24 460m- F3vWA,(, . <br /> / L6t9 rip`+ <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 ( rint): r TESTS WERE COMPLETED ON: <br /> d <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optionall: <br /> / ( � a <br /> CST AT E: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />