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Tp9ENTUF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUS <br /> INDUSTRY, DIVISION <br /> LABOR P.O. BOX 76 <br /> HUMAN REDLATIONS PERCOLATION TESTS (115) / MADISON WI 53707 <br /> (H63.09(1) & Chapter 145.045) <br /> LOCATION: SECTION:IfI <br /> SUBDIVISION LOT NO.:BLK.NO.: NAME: <br /> '/ / /T N/R cfT <. <br /> C NTT OWNER'S B MAILING ADDRESS: <br /> C. G eKo - A STACt_ ��. <br /> USE t DATES OBSERVATIONS MADE <br /> rryye� NO.BEDRMS.: COMMERCIAL DESCRIPTION: (IPROFILE DESCRIPTIONS: ER OLPZ ATION TESTS: <br /> IglResidence ❑New Replace z���-'7 —Z �� 3 <br /> RATING:S=Site suitable for system U=Site unsuitable for system 11 i <br /> CONYENTI O❑NAL: MOUND: IN-GROI,�ND-PO URE: S SOTEM-IN-FILL ❑�G�� ,R� E eED SVS�M�(Opt{ al) <br /> If Percolation Tests are NOT required DESIGN RATE: �Qt rt If any portion of the tested area is in\the f/\� <br /> under s.H63.091511b1,indicate: * ,� y .3 v Floodplain, indicate Floodplain elevation: N <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL PTH TO GROUP DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBS RVED EST.HLGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 <br /> Z q. `lo f te:A <br /> B- 2 <br /> B- <br /> B (/ /7Z t < t < < <br /> B J <br /> "PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERI t PERIOD2 P R PER INCH <br /> P- e °l <br /> P_ 3 iL y . rT <br /> P- , S <br /> 3 - 8 -g <br /> P_ " <br /> _ <br /> P_ u i <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 _q7 ` c t l04. � ��wQ (Z�Q ® 7o Sta Pe, <br /> 4 P <br /> 10 <br /> Q5 _ 1'N <br /> 1 01 <br /> I <br /> I I <br /> +-- - <br /> Ji- <br /> C^ava4lc i _ � -4 i 1 i_ <br /> w <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(pr'nt : TESTS WERE COMPLETED ON: <br /> �Q 5r -7) <br /> ADD' ESS: CERTIFICATION NUMBER I PHONE NUMBER(optional): <br /> ©• L -fv W' 9 71'Q 866- 926d Cot- Ls. <br /> ( CST,5K TUBE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />