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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, - C DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53BOX 707 <br /> HUMAN RELATIONS <br /> (I LHR 83.09(7) & Chapter 145) <br /> GA U <br /> LOCATION: 4'/ SECTIO�T�{o N/I��I�lor TOWNS'HCI P/OA4�ff41' <br /> 11M : LO .:B <br /> %NOLK.NO.: SU,�BDIVISION NAM E: <br /> COUNTY: p�• eWI1 R' OYER NAME: AILING ADDRESS: <br /> A-A 77AIX-1,2 01'tw ACF of, FA :Niv S3 y <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFI— LE�DES DESCRIPTIONS- PERCOLATION TESTS: <br /> sidence 1174ITew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system O Q 7 <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SVST EM:(optional) <br /> CSS 0 El ElS C ❑S C� [:Is Cott N <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.0915)Ibl,indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH 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- l 8.29 j /YoNC 7 �� ave B,v Nu�ru s o <br /> B- S am ta 3 s <br /> B-3 I 75 {0 7 7-5— h1t AIV I iqgehrit53 / v <br /> B- 75 7 7� A At //& rc 5 ! E S o <br /> B,I" "3 7 s atiks /F45 <br /> IB- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERI D2 PER PERINCH <br /> P- NO d' <br /> P- o 0 3 <br /> P- o <br /> P- <br /> P- <br /> P- ��/ <br /> PLOT PLAN: Show locations of percolation tes# oorings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- <br /> zontal and vertical elevation reference points ands it location on the plot plan. Show the surface elevation at all borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION G6'on;Nc.s <br /> 7Sr Blur of f <br /> CA <br /> ?o l TN <br /> I � <br /> / = ' I <br /> 0 <br /> a - ,OeR c <br /> 7•(0 "x oo' <br /> 1,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(printf: TESTS WERE COMPLETED ON: <br /> c<L - //- A9 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> CST SIGNATURE: <br /> r <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R 10/83) —OVER — <br />