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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY,- - - DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON,WI 3707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) &Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> 1/4 1-7 1/ /3 /kbN/Rl6E (p )W <br /> COUNTY: OWNER'S BUYER'S NAME: MAIL NG ADDRESS: <br /> RVeTT - Fe RT- , _ <br /> USE DATES TIOI S MADE STS: <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: IPROFI LE OF TIO NM OLATION TE <br /> ��7}{Residence C� New SERVA <br /> ❑Replace 6 <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUNDPRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTE :loptional) <br /> rMAS ❑U I RS ❑U QS ❑U I ❑S GNU I ❑S Ca <br /> If Percolation Tests are NOT required DESIGN RATE:''11 If any portion of the tested area is in the ee 77 !!�� <br /> under s. ILHR 83.091511b1,indicate: NA. Floodplain,indicate Floodplain elevation: IV./-T, <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTHTOGROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,CO OR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> B t ' ' " <br /> 'JQ 1004",5LTS 2 " 5ty C--A_ s, <br /> B- 2 S C/1 C' kvpt-- 17S tr " wle- <br /> B- 3 Ot I 991'3' Aiak `I loll N 4r,.. S�- 1!> 6�" 13 M 5 . <br /> B- J '7�'' Gjq'-� I�orx Z" G' ' SL 3l , 5 0` I� <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 PERIOD 3 PERINCH <br /> P. <br /> P 1 7 3 _7113� .. <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 disgances. 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 9�7 —' 0" y� 2�N�z C c O"4455 <br /> �t4KE lSCD6 �� ' G �I O 39S t a <br /> TN <br /> LoT y <br /> I I <br /> y� z <br /> I 01 I <br /> 6 to lot LCOS <br /> l ) <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 WERE COMPLET D ON: <br /> tick/) <br /> ADDRESS: i CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> R r 6 a c-00 t 4i /t1, sirs3o /-/6�;_ I 21S--2qq 36-05 <br /> CST SI <br /> 7 <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />