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D)PARYMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, IVISION <br /> P.O.P <br /> LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707 <br /> HUMAN RELAT ONS <br /> 0LHR 83.090) & Chapter 145) <br /> LOCATI SECTION: Q p� TOWNSHIP/MUNICIPALITY: LOT NO.:BILK.NO.: SUBDIVISION NAME: <br /> 14 '/ /T37 N/•` /0 for R !i <br /> COUNTY: OWN R'S BUYER'S NAME: MAI,�LiiNG ADDRESS: <br /> v c T fh _071 'c ' <br /> USE DATES OBSERVATION S MADE <br /> NO.BEDRMS.: COMM ER IAL DESCRIPTION: PROFIL DE CRIPT NS: ER OLATION TESTS: <br /> (Residence q A' ❑New Replace ���� /98V <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: INN-GROUNUPRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDEDSYS EM:(optional) <br /> ®$ ❑U ❑S �U $ ❑U ❑SN U I El Une. 22 1ro H <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. (LHR 83.09(5)(b),indicate: L SS 1 Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, CO OR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST— TO BEDROCK IF OBSERVED ISEE ABBRV.ON ACK.) <br /> B- 1 qS. 3!r /yoNc 7 56 G"Nri' LS-16"9/y L5- 4'' .v 5 !a <br /> B- 2 7 q4"f-;r A101VaX 7 7 `8N Ls is -g I,- NL _ '*C*o ;z <br /> B- 3 / 6 /00,01 IV,) 414' //A BNL5jf9 1G'B&LS- r0`' N �ob- I " NSA <br /> B- <br /> B-Mo A7 "-'o!, '' AA6 . i Lily N• iL I too PA c1n7T <br /> B- T 80 o iLL APpC <br /> PERCOLATION TESTS <br /> NUTEST MBER INDROP IN WLEVEL-INCHES <br /> CH S AFTERSWELLLING INTERVAL-MIN. PEPiOD t PER ODEPE//R D 31 /RATE ES <br /> ER INCH <br /> P- <br /> -a- <br /> P_ <br /> P- 4 L I <br /> N <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 bort ngs and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION !7,1. 8h' <br /> SEE <br /> /0 /f/loc'm 54,9P-'& r-oR <br /> p�oNl�R y"a <br /> 061r�-5ff/+101- 6Ysre1VI fo M"r (fiojt` <br /> TN <br /> I. <br /> if i <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 he 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 COM PLET I ED ON: <br /> _30—ADDRESS: CE TI FICATION NUMB R IPHONE NUMBER(optional): <br /> L vo K w ' Y l S 8S3 Orr o <br /> CST SIGNATURE: <br /> DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/63) —OVER — <br />