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L� <br /> 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 /> (H63.0911)&Chapter 145.045) <br /> LOCA ,SON: SECTION: TOWNS /MUNICIPALITY: LOT NO.:BLK.fJO.: SUBDIVISION NAME: <br /> Efor <br /> CO TV: OWNER'S BUYER'S NAME: MAILING D RESS: <br /> axZJVe <br /> USEVV DATES OBSERVA NS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS, PER O ATION TESTS: <br /> Residence New ❑Replace i <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIp 1L: MO❑UN D:�� IN-GROUND-PRESSURE: SVSTEM-INFILL H O L DINGTAN K: RECOMMENDED SYSTEM: ptional) <br /> C ❑ <br /> S ®U S S ®U EIS <br /> S U 11TJ�-C/�II S U ,�vg �a <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: 0 L q I I Floodplain, indicate Floodplain elevation: A <br /> PROFILE DESCRIPTIONS & <br /> rB-3 <br /> TOTAL DEPT TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE, AND DEPTH <br /> DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> / 0 1 NLS: S_ <br /> Ar/o �r /01°!7 <br /> 3 y7 ig /VDN.-e./ 0 /o BL.SG S_ /.rho 1� � ' N � s4 w0y, <br /> B- io,�, 8A 0 A <br /> G <br /> n i� /oho G2� <br /> B 3 �l q• o .� l ri r <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERIOD PER INCH <br /> P_ O/ Qi <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 ELEVATION 0L-di V]74&ham Hi. 10 <br /> WA,C,iR/vis wkMl40 <br /> r U41V F Ro/4-d ; <br /> yIiOAL <br /> i BM 1 o I 9 ARE TN <br /> j <br /> tRP pRca�.L ilYx <br /> 8L d yWA <br /> Pfi d0 <br /> i l�15 <br /> /,H u rL/1✓_1,the 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 /> // � //((L o v 0 1 <br /> Ln 1 <br /> ADDRESS:• CERTI ICATION NUMBER- IPHONE NUMBER(optional): <br /> '3 is o <br /> CST SIGN T R : <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. LIT, <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />