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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 /> (H63.090) & Chapter 145.045) <br /> LOCATION:;y SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SVBDI VISION NAME: <br /> 1/ 14 /T N/R pr) <br /> COUNTY: O N R'S BU ER'S NA E: MAI S: <br /> 7 `. .-f' ' C <br /> AV <br /> USE - DATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMMER IALDESCRIPTION: ��yyII IIPROFILE DESCRIPTIONS: PERCOLATIONTESTS: <br /> 7�Residence }c�New ❑Replace l ✓ q / .(/O tp� <br /> RATING:S=Site suitable for system U=Site unsuitable for system 1111 7—/- 7 �✓ <br /> ONVENTI NAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> Os ME ❑s ISlu EIS 91u I ❑s D u �'B <br /> If Percolation Tests are NOT required DESJ;MIGN RAT If any portion of the tested area is in the <br /> under s.H63.09(5)(b),indicate: - JZ Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALPTH T N R UDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IIN, ELEVATION OBSERVED EST.HIGHEST— TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B 50� <br /> B- L L <br /> B- <br /> B_ Z rre yX . v � � � <br /> BJA <br /> - <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. P RI D1 PERIOD 2 PERINCH <br /> P- <br /> PAli A <br /> - <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 style or distances. Describe what are the horn <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 /> ELEVATION ioz,�( L�+K <br /> SYS <br /> 7iQfl� <br /> 7Of <br /> oR : Ska �Ivo7�vit3 <br /> rR ;l R <br /> /OQ(O <br /> ,>7t qE/—,P0/lV r- <br /> 0 <br /> o F'grr?ro-'0613, <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord res an�cified 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 /> 5'('Ly —'.4— <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> �/ l ' G10 it — <br /> CST SIGNATURE: <br /> r <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />