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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> UMA <br /> AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> H <br /> HUMAN RELATIONS <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> (/.) 1/ 1/4 36 /T I N/R 6 E (pr) swiss 5 0A ,UA <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> 0 0o w <br /> DATES OBS <br /> USE ERVATIONS MA E <br /> OI�cNO.BEDRMS.: COMMERCIAL DESCRIPTION: 7X�7l PROFI LE DES RIPTIONS: PERCO LATI ON TESTS: <br /> iqResidence rte_ IN New 11 Replace I S - L_7 l <br /> 2 t <br /> RATING:S=Site suitable for system U=Site unsuitable for system C,t <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> MS OU <br /> l Js ❑u CJs ❑u ❑s ®u ❑s ®u n► O L <br /> If Percolation Tests are NOT required DESIGNG� I If any portion of the tested area is in the <br /> under s. ILHR 83.091511b),indicate: It Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1J.6 00.1 901J.6 >qo © y&� �fy�iKs �fY 90Pwnrs <br /> B-2 7Z Z tl >7Z �'Y,811nS -6D BMS <br /> B-3 72 � 72- 0 <br /> B- 4 9d 101. I� > 10 2- go <br /> - <br /> B5 > 77- S&A16 A S b- 7— <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 PERI002 -FIE—R-17i—FIE—R-1PERINCH <br /> P- ' T6 No z <br /> P- 2 I B 1 2 3i 3 <br /> P- 3 NOS <br /> y <br /> KP- <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 <br /> Lffr <br /> Wig <br /> u i p <br /> -SCALE ( - 'WiLaS urns o <br /> AjW 10b PAIuu P'Xrp ORK ' A LAK6 <br /> Ct PER(- <br /> 0 <br /> ERS• YDIZE 0 (07 .3a <_ <br /> wUI liabE*-!5b f to 5y5-(6Ikt IN <br /> Lj s <br /> X07 L4M <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 (print): TESTS WERE COMPLETED ON: <br /> &(CMEO AC26005 - - Z3 - S1 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 0 15 $1,6 I S <br /> CST IGN TUBE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />