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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, 1 C DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> BOX 76 <br /> HUMAN RELATIONS <br /> (H63.0911)& Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIPAM4JPIIGIPAa-Fi�V: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> I/ 1/ a /TScN/R/yE to sl if i �s — <br /> COUNTY: OWNER'S BI+YfR'5-WANE: ILING ADDRESS: <br /> MA <br /> O i G. d <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDFIMS.:1COMMERCIAL DESCRIPTION: PROFILEDESZ—RPTIONS: OLATION TESTS: <br /> ®Residence 2 NA ®New ❑Replace I 9-�e •�s 9ae •g.r� <br /> RATING:S=Site suitable for system U=Site unsuitable for system 7 J 111 <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ©S ❑U ❑S ®U 1 . NS ❑U ❑S ©U El ®U ppm Lt z"rw yii,.,y tit <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s.H63.09(5)(b),indicate: NA 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. HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B , T L./ A10 73 S <br /> B- a 2. 8.L Z ,,,� S w, <br /> B• '3 8y .0 >3Y z44,i- 2 5 F <br /> B- S i SIG •G 7 z 4 . S8' R S . S <br /> B G 79 rf� b' 7 ?Y v a' 4- e <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. pERIOD1 PERIOD PERIOD 3 PER INCH <br /> P- i 3 i 3 s' <br /> P- z 494 1 C <br /> P- 3 f. 3 v 4 u <br /> p- q Ry Jk, 4 <br /> P- 1 3 S S <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 an. Show the surface elevation at all borings and the direction and percent <br /> of land slope. .1) <br /> SYSTEM ELEVATION 91/i ' o _+ <br /> ,B r% =a S?IkE ov rw" &-'V'oAC -ifpYI <br /> How <br /> [.°zCkWo 12oaMrt ZoAD r N _S 94-3S <br /> #il4c o $ X4- rpt _ IIsi P TN <br /> SL.CawD COT r am•.1 0 F. 9-01 <br /> Li D l0 _ <br /> surcflR]bc <br /> IN47k1L <br /> _ u �• _ <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): TESTS WERE COMPLETED ON: <br /> {� a 6 -ows- <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBERIoptionall: <br /> P Loy <br /> 7�S- <br /> CST SIGNATIQRE: <br /> ' C3.ws 2 <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />