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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (ILHR 83.090) & Chapter 145) <br /> LOCATIO : TOWNSHIP/MUNICIPALITY: LO NO.:BLK.NO.: SUBD : <br /> ' V4 � SECTIONVISION NAME <br /> Y, /T CN/R (or)W OAK-LAW <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> ADL) E SDws V, <br /> USE DATES OBSERVATIOt,SMADE <br /> NO.BEDRMERCIAL S.: COMMDESCRIPTION: PROFI LE DESCRIPTI NS: R OLATION TESTS: <br /> Residence New ❑Replace <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> ONVENTI ONAL: OUND: IN-GROUND�PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM (optional) <br /> ❑U $ ❑U $ ❑� ❑$ CSU ❑$ � CO1G✓. <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: t���/ Floodplain,indicate Floodplain elevation: <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 F ACK.) <br /> B- � $0 ojj.1 NONe 710 0-5 811C MS a- k BNF <br /> B_ �' <br /> B- <br /> B- <br /> B- 100-� I( SamE AS 6--2- <br /> B- <br /> -ZB_ r00 .y I\ " Sawt,;F As f,-2- <br /> 131- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PE RIODI PERIOD PERIOD PERINCH <br /> P No 5 3/ "i <br /> P- 2 0 n 3 y <br /> P- n v y 2 <br /> P- <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or dista ices. Describe what are the hori- <br /> zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent <br /> of land slope. Q ncnG5CNG67 /11 to/ <br /> SYSTEM ELEVATION q 2 6 is &e-E7 . 6M OIL IN fib", Flo PPu6 <br /> weu-ta Be 5D'AW19 j�rL SUITA_46E A e6A <br /> Lot tAkC <br /> 86D6 <br /> A TN <br /> P I y Rw�� <br /> 3 �367d <br /> a <br /> Lot LIr� <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and me hods specified in the Wisconsin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> NAME (print): TESTS WERE COMPLETED N: <br /> �r�I RSD ({oP,�iNs y- <br /> ADDRESS: CERTIFICATION NUMBER PHONE NUMBER(optional): <br /> l��dsrt 2 tit s4$ 3670 25 -$66-115 <br /> CST SIGNATURE <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />