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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: OWNSHIP/MUNICIPALITY rOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> /^-/ /T 7N/RI E (or d— E, NaAIhow Nall <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: y/D 1V)AR3/{fl• <br /> U g 6R777o9 <br /> USE DATES OBSERVATIONS MADE <br /> rtyye� NO.BEDRMS: COMMERCIAL DESCRIPTION: PROFILE DESCRRfPTIONS: PERCOLATION TESTS: <br /> I.bl Residence MNew ❑Replace <br /> S 4—/98f NoN"e <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TAN K: R ECOMM ENDED SYSTEM:(optional) <br /> ❑S ®U ❑S ®U ❑S SIU EISU LIS VU DRi Ke <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)(bI,indicate: Floodplain,indicate Floodplain elevation: �'t/A. <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- <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERIOD PERINCH <br /> P- AlaAQ <br /> P- <br /> P- <br /> P- Y <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 /> I <br /> IVh Y r45� <br /> IbEt llt µ1'QLdhil_4i 04-Y aposer� 1 <br /> 6l d,`1 <br /> ARCA �[ao <br /> TN <br /> ARI` v <br /> Rte" <br /> U aoo' <br /> oROAD <br /> u �,,�/�t/fLt7 <br /> I, the undersigned Ce7tifY thdt the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin <br /> Administrative Cc ,an that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> NAME (print)i TESTS WERE COMPLETED ON: <br /> iL' oM 5-4—Iffr <br /> ADDRESS: L (J G K W II /'f �� § ��%✓ CE RTI)= CAOTION NUMBER /f1 4�ty nall: <br /> CST SIGNATURE: <br /> W <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DI LHR-SBD-6395 (R.02/82) —OVER — <br />