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DEPARTMENT OF ' SAFETY& BUILDINGS <br /> INDUSTRY, REPORT ON SOIL BORINGS AND DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (H63.0911)& Chapter 145.045) <br /> LOCATION: SE T N: a TOWNSHIP/ Y: LOT O.:BILK.NO.: S BDIVISI NNAME: <br /> �� a /T *N/R/OR(or)W Irl fT�va n/4 /l/ <br /> C/O�k/�NTV: OW ER'S BUYER'S NAME: MAI IN ADDRESS: <br /> L n <br /> f � T t <br /> USE DATES OBSERVATIONS MADE <br /> rrI NO.BEDRMS: COMMERCIAL DESCRIPTION: PROFI ED TIONS: ER OLATION TESTS: <br /> IL�R¢sidence New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system P <br /> CONVENTIONAL:TiOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMM NDED S S EM:(optional) <br /> ❑S ®U ❑$ ®U ❑SCRU EIS [A �S ❑U allYrt <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in th <br /> under s.H63.09(5)(t indicate: Floodplain, indicate Floodplain elevation <br /> PROFILE DESCRIPTIONS <br /> BORINTOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBERG DEPTH IN. ELEVATION OBSERVED ES IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. N BACK.) <br /> B- 7a 97 ptwe a d 11oei r " sc "c 016 s <br /> B 1- a /v o " y 6 y `'tQ g " is ` C q " R f-s <br /> - 3 " a v•el,7t .s'Isl ,y, !? 91 " RFS' <br /> B- 0 d ,t- F__ s 7- <br /> B- ? C <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD2 PERI D3 PER INCH <br /> P- <br /> P- <br /> P- <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 ELE ATIONW (A.. a f /i <br /> itnC k v)wdtihR <br /> S <br /> a_ ! x i <br /> ���14z) �F1-3 Sov <br /> %J �_:0714 <br /> t� I,� <br /> I <br /> f,Y <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures a id methods speci ied 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 beli 3f. <br /> N (prin ): TESTS WERE COMPL=TED ON: <br /> r r OQ l6liI j 6 — J�o - c/ <br /> DRESS: J t CERTIFICATION NUMBER- PHONE NUMBER(optional): <br /> is-e 4 T Pr`s S g8f3 el3y7 71 r 66- 'Ar <br /> CS <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/62) —OVER — <br />