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DEPARTMENT OF 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: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> 9)u) '/a'/ 3 /T N/R/6 E ( r) w3 ?0A N a N4 . <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> u4 f o FF'E f Ctl W & <br /> USE DATES OBSERVA ONSMADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILEDE RIPTIONS: ATI ON TESTS: <br /> Residence Ar New ❑Replace I 6_ � / —�5 <br /> RATING:S=Site suitable for system U=Site unsuitable for system O t9 Ti <br /> CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> V S ❑U [IS �U ❑$ [�U [IS ®U ❑$ EZU1 o6F;kj-601, ,A--e- <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)(b),indicate: -- Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL ELEVATION D PTH 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 ( q i r <br /> 8 99- QOE7 78 7"5-c 13) 7_s. 26" fS 38'5AvITS 5.9N/)0/ 64, .s, <br /> B- 2 7r 9 Nolte{- �' 5 "Sj Br -2 F5 <br /> B zN 916 ow 7 2-' rr �FJ 7-S. a1� F:5 -12 � $u <br /> -/ f <br /> B n ' IVOU� ? 7z L % 59' gNLS SAID <br /> B- txtic 7y cj" sk tb2z' P- -V!; - 9C)" F)Iutc, <br /> B- <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 I PERIOD 2 P R PERINCH <br /> P- 1 " /doh - 10 3 3/ '� 3 ,( <br /> P- 3 I I 3 <br /> P. " - 3 IVA <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 97 tRopv. 6/+r) <br /> 0 <br /> c�N <br /> 3 ToL © -: <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 /> ro uf20 SS- 2&,-e55_ADDRESS: _ CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> Q �j �lnS 2yq- 373 <br /> CS URE: <br /> �i <br /> AC <br /> - it— <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />