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DEPARTMENT OF REPORT ON SOIL BORINGS AND ' I SAFETY & BUILDINGS <br /> INDUSTRY, �,I"_ DIVISION <br /> LABOR AND - PERCOLATION TESTS (115) / MADISON WI 53707 <br /> HUMAN RELATIONS ' <br /> [, (H63.09(1) & Chapter 145.045) <br /> LOCATIO; / SECTIO/T 7 N/R/6�,or,W TOWNSHIP/�hFY: LOT NO.:BLK. O.: SUBDIVISION NAME: <br /> 11/IVV�tCEc 3Jf= c h<.r <br /> PUNITY: e�- OWNER'S ME: MAI LNGIADDRESS: <br /> I / f 1 4 Cu If 47 ® Q 4 4 nA J •x s T � F� <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: LE DES RIPT ONS: ER AT ON TESTS: <br /> Residence � �N ❑Replace P�-FI <br /> RATING:S=Site suitable for system U=Site unsuitable for system C <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ®S ❑U NS ❑U NS F-111 I EIS ®U I ❑S mu coAl0 <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s.H63.09(5)(bl,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 ES . IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- � �Q � o � ode > S�' S "dN41 /� C $ <br /> B- a 88 9 7e�' � 'relyes 3 " r C s <br /> B_ d.� f > 6V � sI'6'aL s 3 !r' c s <br /> B- 88 97 � gb' "��Is <br /> B- s S' 'I y ;F $ S_f 14 -T (s <br /> B- SY !S` " > 88 s "1H l S3" ? c s <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 1 PERIOD PER11OQ 3 PERPER INCH <br /> P_ le -10 to 3 1 3 r8 (� <br /> P_ 3 ' 0 0 339 3 ! <br /> P_ ? 3 3 <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 scope. <br /> STEM ELEVATION <br /> 0-4 <br /> a� � IDrn6r c lr�e <br /> 4 � _ <br /> l9 a •p IN <br /> Q 3 c <br /> 0 4 perc ti Qor < W8e,r C] <br /> R YFT <br /> Go S4�fcr6 <-e a <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 /> NA (prr t): L u t TESTS WERE COMPLETED ON: <br /> bITtic7 ITo , h' . �1r „ 6 - fOF3 <br /> ADDRESS: <br /> w 6, Tr Esc . s- 4CERTIFICATION NUMBER: HON-N <br /> 9'.37 <br /> 3 / s y/s�BR(optional) <br /> 3 : <br /> CS GN TURF: .t�/1 , <br /> <llJj <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />