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DEPAR <br /> INDUSTRY, °F REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSY, . DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON,WI 53707 <br /> HUMAN RELATIONS <br /> (H63.09(1) & Chapter 145.045) <br /> LSO"CATION: ' SECTION. E_'3:?�N/ <br /> J TOWNSHIP/MUNICIPALITY: LO1T NO. BLK.NO.: SUBDIVISION NAME: <br /> `��l) �� /4 oL� /T1�/ lorl W `t ►'l C !� NSA <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> t L' (- F r\ l E S r 1S C <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: �[�j ❑ (PROFILE DESCRIPTIONS: PER OLATION TESTS: <br /> Residence RSINew Re lace <br /> LN <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ®s ❑u s ❑u s ❑u ❑sou ❑s au N If Percolation TestsareNOT required DESIGN RATE: If an <br /> y portion of the tested area is in the <br /> under s.H63.0dicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORINGI TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B-3 7,)L <br /> PERCOLATION TESTS i1) <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH <br /> P- 3 v <br /> P`a <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 <br /> AYE � <br /> yCt; <br /> S .T 4 <br /> TN <br /> to a T A-, <br /> /V1 /C c <br /> v <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 /> NAP(prip0: TESTS WERE COMPLETED ON: <br /> ADDRESS: f t CERTIFIIC/ATI+O�N�NUMBER: IPHONE�7rNUMBER(optional): <br /> CST SIGNACr <br /> u` <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />