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DEPARTME,NT,O,F -REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (H63.09(1) & Chapter 145.045) <br /> LOCATION: c�*� S�EjCTION:T(� p/ TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> ��7J }4 �, 1 7�� H/IVSP(or)W � .Sl�A / <br /> C UNTY: OWNER'/S/BUYEEH'S NAME: MAILING ADDRESS: <br /> USE DATES OBSERVATIONS MADE V <br /> NO.BEDR=COMMERCiAL DESCRIPTION: (PROFILE DESCRIPTIONS:1PERCOLA TESTS: <br /> Residence New ❑Replace S'. 3` Qp U s 3 G� +� (/ <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: I�ZS <br /> ND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> �S ❑U OS ❑U ❑U ❑S DU ❑S FilU I 4C7o <br /> If Per�s.H(53.09(5) <br /> tion Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the <br /> under (b1,indicate: 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. N BACK.) <br /> B­� 7 �L •i L 4j Y}M E. <br /> B- d S <br /> B-S' it <br /> h Ls !I ✓Vv�Y <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT D 1 PERIOD2 PERIOD 3 PER INCH <br /> P_ 4TS P- <br /> P_ <br /> P_ E <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 �� �Jrc, , r►-c <br /> ' r r <br /> s7� <br /> �y1r3�' <br /> C Q <br /> q , <br /> C � <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 1: TESTS WERE COMPLETED ON: <br /> S- _ � � Eq <br /> 0(prin <br /> ADDRESS:/ - f CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> q,3 1/3-1 = /� <br /> C GN,gnTURE: ' <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />