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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (H63.0911) &Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BILK.NO.: SUBDIVISION NAME: <br /> sVj �/5'�/ 3 h /T ioN/RISE ( , 'Twti 6 <br /> COUNTY: OWNER'S 'S NAME: MAILI G ADDRESS: <br /> Nc <br /> USE t, 1WDATE OBSERVATIONS MADE <br /> Ir NO.BEDRMS.: COMMERCIAL DESCRIPTION: rr{�� PROFILE DESCRIPTIONS: ER ATION JESTS: <br /> Residence 2— LgNew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IIV-GROUN6PRESSURE: SYSTE(�M-IN-F I LLHOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ®S ®U ❑S ❑U ®S ❑U ❑S DU ❑S ❑U <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 DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- L <br /> lam'.. i/ I i <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 PERIOD 2 P R PERINCH <br /> P- ! 3 6 A7 0 vc— 3 fo <br /> P- 2- 3 6 - / r <br /> P- y or, <br /> j 6 7 l3 6 <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 Aa, a i ,pd ; X 4 ,f <br /> -foo . <br /> lr fd s r� fV. <br /> t <br /> A Ae oafc hlJjzrd <br /> 3 /Un} 1S l Y _ _ <br /> �N <br /> F/. h <br /> doe c _ &&dt'.1� _p { <br /> A110 <br /> C7 <br /> k kkx xx fi3 <br /> K r x x <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 /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> ?3e n'11ro�� N � 54 5'S 5S z>�o 466-v� r3 <br /> q CST SIGNATURE: <br /> '�y[e, <br />