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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 /> LOCATION: ECTION: TOWNIC IPALITV: OT NO.JBLK.NO.: SUBDI VISION NAME: <br /> '/ LY 3 /T3 0/yE ( W 74s/< /z — w/Y <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: // <br /> USE DATES OBSERVATIONS MAD <br /> ��// NO.BEDRMS.: COMMER�!AL DESCRIPTION: ��;;�� S: A TESTS: <br /> k Residence Z— L7New ❑Replace 6 _ Z a 01 -el <br /> RATING: S=Site suitable for system U=Site umuitable for system O /tea <br /> CONVENTIONAL: M❑�.� IN-GROUN O URE: SVS❑TEM-IN-FILL HOLDING TANK: RECOMMENDED SV TEM:(opti nal) 6 <br /> Ers <br /> If Percolation Tests are NOT required DE*N/RATUE: S Lr-'J]{},' I If any portion of the lot is in the <br /> under s.H63.09151161,indicate: 2_L1/ 9q 1/ /r I Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. HHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- ! C /I/ C 7 .2 F1/ ✓ // fS r !/ <br /> 3 S <br /> 99•/ 9 <br /> -.5- <br /> 92, 3 <br /> 13-3 pL/, / ,/ '�:- 7 /-z / <br /> 49-7 9 <br /> y ,3 <br /> BE• B- 4P 2/ v a 7 1Y1 7rol <br /> B-m 3 d ri <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD 2 P If_R11-5-0-9— PERINCH <br /> P <br /> P- <br /> P- <br /> P- — / <br /> P- <br /> P- <br /> PLAN VIEW: 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 slop. <br /> SYSTEM ELEVATION <br /> O bore �OA5_' <br /> (,arc /tale nt071A/at9. a" A�+yTr` •g/ qd/ , sc. mow[ 'TV <br /> 3M 01 5wwed ZZ Loo.O } of a/et// '!`/'//` >i " rj�� rc JeWIA�/ <br /> ar rtfe�wL. 'p'rAs.E/�. <br /> X.'L A / <br /> � sig / <br /> sr <br /> e,u%ar��lr <br /> W <br /> !, the undersigned, hereby certify that the soil tests reported on this form were m-a a by me in accord with the procedures methods specified in the Wisconsin <br /> Admimistrative 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 /> Z/ ` Ui - Z 2 -9,->--"ADDRESS: a6ze �, CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> Z 3 3 71 G (o <br /> C ATURE: <br /> 3 <br /> DISTRIBUTION: Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester. <br /> DI LHR-SBD-6395 IN.03/81) <br />