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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/DAIJNICIEA4tT-Y: OT NO..B BDIVISION NAME: <br /> !/4 /T N/ E to Q5c,ui.f)'5 <br /> CO TY: MAILING ADDRESS: <br /> 1 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: �PROFILE DESCRIPTIONS:[PERCOLATION STS: <br /> Residence XNew ❑Replace I��v�1.,� KJ/NND �l1/ /5/w <br /> RATING:S=Site suitable for system U=Site unsuitable for system ��f�� / X� �`.J, <br /> CONVENTIONAL MOU D: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:REC MMENDED SY TEM:loptio all <br /> s ❑u WS 1:1U s ❑u os u os u <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> 9 If any portion of the tested area is in the <br /> under s. ILHR 83.091511b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL P H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) /- /��//� C <br /> N 4 /J/ Y Q�/ / �C.� SJ/ ��l <br /> 14 <br /> B- Ca" 97l� /tlor�e, > 7�" �C1rne C5 <br /> 1 B_ 0-711101 A?115; <br /> S I& ki 6 <br /> B- <br /> is PERCOLATION TESTS <br /> tiTEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> i NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RIOD2 PERIOD 3PER IN H <br /> P 3 <br /> p- 33' <br /> P Ori — <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 ELEVATION <br /> , <br /> i <br /> >�.�%-✓c�.Q ,�nelrr.�r�, ,clay% <br /> 17 Lrise o/ /S °,lea Cb <br /> Pere <br /> { a� 4,65/ - <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 /> NAME print ITESTS WERE COMPLETED ON: <br /> I / __ q90 <br /> ADDRESS' CERTI (CATION NUMBER: PHONE UMB (optional): <br /> �, Cref� e1 1 1-515JI15 <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Awhority, Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) — OVER — <br />