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TMEN?OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUS <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/lAW4i6 "4+ OT NN BLK.N9.: SUBDI ISION NAME: <br /> W 1/ a 9 /T*N/R obi(or)W 0 4 n d NSF A�/h fF <br /> C$9,UNTY: OWNER' BUV R'S NAME: MAILING ADDRESS: _ <br /> D4�n �eTfi CNo,, Orr r+rf 0 311 0-e y SSr 3 <br /> USE DATES OBSERVATION MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: P""RO��'FI E D p 10 S: E ATIO ESTS: <br /> I�'R esidence New ❑Replace 3 O U i/ 0 ,{� <br /> RATING:S=Site suitable for system U=Site unsuitable for system 7 f! <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FI LL HOLDI NG TANK: RECOMMENDED SYSTEM: optional) <br /> ®S ❑U �$ ❑U $ 0 E ❑$ ®U (!. o a/v, <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: I 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—IGHEST TO BEDROCK IF OBSERVED (SEE A .) <br /> BBRV.ON B CK / <br /> B- I S 9 I NoN�`Q > 0 SSri?uS /d Ve, a,,le Ills- ” /1►ve d <br /> B- D– 71 9''7, `f 7 71 `t 43 ire t wvx e //s S6V ^n r t <br /> B-3 8s <br /> B_ 'ru L s <br /> 0- <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 PER 002 PE PER INCH <br /> P- 140 Jyr 3f1r. s/ <br /> P- '3. 8 itu 1 0 y d // a- <br /> P. O <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 distar ces. 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 borin is and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION AItRRP*A Ss�•ElQ- 9G/r7 <br /> prC • <br /> e6 ►y "re. citr am, goo <br /> sn rtC �Ys <br /> y _ TN <br /> Som` 1 #4nr 4.T L�►v � <br /> ' rr y d i -_eXe qeT <br /> o c� �Y ti ' iUoTt <br /> I,the undersigned, any 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,a that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> NA E(pn I: TESTS WER MPLE DON: <br /> o �� rf c -Ka /n �Q <br /> ADDRESS: CERTIFI IONNUMBER PHONE NUMBER(optional), <br /> 7 7�s -Vi3'7 <br /> C NA URE„ <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DI LHR-SBD-6395 (R.02/82) —OVER — <br />