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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, : _ 1 1 C DIVISION <br /> LABOR AND � -PERCOLATION TESTS (115) P.O. <br /> BOX WI 7969 <br /> HUMAN RELATIONS <br /> D (ILHR 83.09(1) & Chapter 145) <br /> LOCATION iV� �Jc.►��/ 33O%T�ON�RI��(or)w TOWNSHIP/M�: LOyi�.:BLK.NO.: SUBDIVISION NAME: <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: �N /,y///i/ ,�✓` <br /> g4rne 7 J� � � C4.,., s W � S / `ter wr' <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> ❑Residence /'� n XNew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable/for system (J <br /> CONVENTIONAL: M®ND: �� IN-GROUNDP©SSURE: SYSTEM-IN❑-FILLHO❑LDING®NK: RECOMMEND �EM)(optional) <br /> DESIGN RATE: /'/' f�C <br /> If Percolation Tests are NOT required I 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 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 /> B ' 3 q�. ,v o U! a "asp .M t �.� a y " •,~,►.� l <br /> B- 3 � 9g, � , , 0*16 6u411641 W_ 01 "KW <br /> / ~ '2 r0 `le It rrK.� �r a �'�" .wt •t� S' <br /> B- L ^ <br /> B- # q,s <br /> PERCOLA ION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER/SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PPERIOD 3 PER INCH <br /> P_ d /o � o oa 3iy YA of gi <br /> P_ ay o a a3 A3 <br /> p_ a N.!ej e / 02 s .2 � <br /> P_ <br /> P_ <br /> PLOTPLAN: 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 p rce <br /> of land slope I[� �j V •p f% O S ?d `� y `Q � <br /> SYSTEM EL VATION r-^c • <br /> /3 vs-e en c> t <br /> T*.e aT� y <br /> P%' fi <br /> L <br /> 0 . <br /> tiros <br /> 1vo Tti r{oe ' :.'' To M.Q ;u <br /> y 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 (prin ): TESTS WERE COMPLETED ON: <br /> -r,ric /T e l�Ctn r 91- /'r4 Y— <br /> ADDRESS: CERTIFICATION NUMBER: PHONE N BER(optional): <br /> CST,tGN TURF, tF <br /> i <br /> DISTRIBUTION: Original and one copy to Local AuO, r-ru(�erty Owner and Soil Tester. <br />