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b REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> DEPARTMENT OF DIVISION <br /> INDUSTRY, I P.O. BOX 7969 <br /> LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707 <br /> HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/t�T'TV: LOT NO.:BLK.NO: SU�IVISIONN MEf <br /> �'/a /TyoN/R/61woIN p Zan (iicu <br /> COUNTY: OWNER'S BUYER'S NAME: M ILING ADD S: <br /> r P QM�rS ? dQ crer <br /> DATES OBSERVATIONS MADE <br /> USE PROFILE DE CR PTIONS: ER OLATION TESTS: <br /> IIgg' NO.BEDRMS.: COMMERCIAL DESCRIPTION: Iy�;' t <br /> P_mesidence 1 y�+vew ❑Replace I s' <br /> RATING:S=Site suitable for system U=Site unsuitable for system v V <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> �S ❑U NS ❑U ®$ ❑U ❑S © ❑SOU 47, 0wN <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 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 BACK.) <br /> 13- 1 IvQIII-e <br /> B- � �' � b', )rpty_t 1;> <br /> B-3 g � 9 7. 6 � � � ,, � 7.T R �. � S <br /> s " - 7s tr /v„ r <br /> 7 � S <br /> "'esil L <br /> B- <br /> PERCOLATION TESTS <br /> WINCHES <br /> ATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> TERSWELLING INTE VAL-MIN. PERIOD1 PERIOD2 P RPER INCH <br /> o ® /a 7310 oPLOT 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 plat plan. Show the surface elevation at all borings and the direction and percent <br /> of land slope. �'� a � / t' z 7 o ' <br /> SYSTEM ELEVATION y '9 xCe?-r w1ir " i-4 �e �c 0.F( 0er Nefi< ilBorr b <br /> sok _T <br /> ��• od � , � TN <br /> T �I.acJ <br /> Oar 44 � �J �tr-er <br /> w.ell� to <br /> rtttC. o <br /> Nct FT S'>t4 Qnen <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 /> NAM print : TESTS WERE COMPLETED ON: <br /> A <br /> o N r s— <br /> ADD ESS: CERTIFICATION NUMBER: IPHONE NUMB ER(optional): <br /> .fb6 i <br /> C IGNATI RE: ) E <br /> c <br /> N <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />