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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,W1 53707 <br /> (ILHR 83.091) & Chapter 145) <br /> SECTION: <br /> T HP IT` O . <br /> r�/ '/lN/�� � L <br /> I1TVyV <br /> COU TY: /I MAILING ADDRESS: <br /> USE DATES OBSERVATIONS MADE <br /> ,}� NO.BEDRMS.: COMMERCIAL DESCRIPTION: I PERCOLATIONT <br /> IN Residence ❑New ❑Replace I //'7jy,��i///1!",/7 <br /> RATING:S-Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDI NG TANK:R ECOMMENDED 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: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALP H TO GROUIN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED HET TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> 13- <br /> B- <br /> B_ <br /> B- <br /> B- <br /> B- <br /> PERCOLATION <br /> B- <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> lTEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p RI0D1 PERIOD P PER INCH <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 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 ELE"TION <br /> i T X — — — — 1 --T <br /> /-fin t , t ♦ .__ } . �- ... _.y.. <br /> �.- ✓ Lys - U. I �.. —. ---. t _-It._ d......_7-_-.... f <br /> tN <br /> I <br /> I <br /> I t ' <br /> i I i <br /> I <br /> t <br /> r -- t— <br /> I, the undersigned, hereby certify hat t e soil tests reported on this form were made by me in accord with he procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the are recorded and the location of the tests are correct to the best of my knowledge and belief, <br /> NAME (print) ITESTS WERE COMPLETED ON: <br /> llc/QQ'e 117�a�l'?�/ /99 <br /> ADDRESS: <br /> (oc/SD Tcrc t die O /a3 /�feb� i � CERTIFIC TION NUMBER: P ONE NUMBER 73 � -r4 �5 d <br /> CST SIGNATOR E: _ <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD.6395(R. 10/83) —OVER — <br />