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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: TOWNS H I PIMAH4ILPALLTY: OTNO.:BLKNO.: SUBDIVISION NAME: <br /> Nw 1/, 14 zd /T,,/6 N/R% (*AW Scd� �� <br /> COUNTY: OWNER'S DHYfR'3'NAME: MAILING ADDRESS: <br /> -� <br /> ui2iue.f` .Ce o 7h.e Al / 72 Lem NC gyf S,4 <br /> USE DATES OBSERVATIONS MADE <br /> NO•BEDRMS: COMMERCIAL DESCRIPTION: PROFILE I IONS:1PERCOLATION TESTSEi5a : <br /> Residence V�p ❑New Replace <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: I1 STEM-IN-FI LLHOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ©S ❑U ©S ❑U ©$ ❑U ❑S EU ❑S 19U <br /> If Percolation Tests are NOT required DESIGN RATE: - <br /> Q If any portion of the tested area is in the <br /> under s.H63.09(5)(b),indicate: 144'7 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 DEPFH IN, ELEVATION OBSERVED EST. HIGHEST- TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- / 4-3 9V -5 /146've, s' 6GI a -3" �/ sYTs 3 �a 8, s 6m-63 S/ �,Z,4o eei <br /> B- 7Z 6v 9 7 G <br /> B- `� 6-.v 9. 7 fn0 O-(a"b!'%s/Ts 6- .S9'' ,6n S. S - fid rZ si` <br /> B- 3 p9.s 5 do® 0 P1 Yl 75 3 -Ga " 8n s. Gd - "Sn s'/ w ad <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 PIER100 3 PIERPERINCH <br /> P- s' Z Y 410AJ i / > <br /> P- 2_Y Al 6 N c / >3 <br /> P- 7-y. /Va rlP / > 3 <br /> P- <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of percolation tests, sail 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 ELEVATION97, 7 <br /> 619 <br /> i� d <br /> 1 <br /> /s' F_ WC// 7�e 6e.,i. .y <br /> /.060 ',,e✓ TN <br /> 2 J � <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 /> d/' a 2 — 0,5- <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMB (optional): <br /> f 6. �o '�/ Od,✓ct. Gly` J fid/ .�.u'.3/ 7G6—Z/SS <br /> CST SIGN UR <br /> v� <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. — <br /> DILHR-SBD-6395 (R.02182) —OVER — <br />