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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 /> (H63.0911) &Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/M41446VRAtiTi': LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> '144N� o /T N/R/ �(�,W cys.� z <br /> COUNTY: OWNER'S WUIYI:, NA M E: MA I L I NG AD DR ESS: <br /> �GtR.vef`/G TCD/V-r �P/�C 2 M OCNtis G✓ _S,- -S� <br /> USE DATES OBSERVATIONS MADE <br /> Ir N.g <br /> NO.BEDRMS: COMMERCIAL DESCRIPTION: IPR FILE DESCRIPTIONS: PE <br /> Residence Z.. ❑New (Replace R A IONTESTS: <br /> X0_9 -''� !lJ- 4-P'/ <br /> RATING:S=Site suitable for system U=Site urauitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: R ECOMM ENDED SYSTEM:(optional) <br /> MS ❑U OS ❑U ©S ❑U ❑S [U ❑S ©U s Scd, <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: ry9 Floodplain, indicate Floodplain elevation: /{�A? <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH 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- / /o% 49. 5 A/ouc o� <br /> B- z 44, 9 . <br /> B- <br /> B- <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 PERIO 3 PERPER INCH <br /> P- 20 v <br /> P- 7 /9 Alg.r/c <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 <br /> /Ole ! A10 ses/e <br /> +/'LiCC Csr,/ce /ted. <br /> �FZfiIf-ty!4 --3°- . . P;" �2ee� <br /> � Syat�ri �yL.J <br /> y IN <br /> 12 <br /> a. <br /> je <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 /> 9- Py <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> oeA,1C-1z u1; p/ 3331 -2"-a/ss <br /> CST SIGNA E: <br /> ;35r- <br /> DISTRIBUTION: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />