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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, G DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON BOX WI 53707 <br /> HUMAN RELATIONS <br /> (H63,0911) &Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/WP..'.p'h ;F ': LOTNO.:BLK.NO.: SUBDIVISION NAME: <br /> w'/4N� /TziN/R/4(.iL,-C .i/� ,rA .� <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> V�NC'el S $' ' 8d/ <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: <br /> IgResidence COMMER AL DESCRIPTION: ❑New uv I�Replace PROFILE DESCRIPTIONS: ER ATION TESTS: <br /> Z s1/9 8—Ly_ pit y <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: nlil-IN-F I LLHOLDING TANK:R ECOMMENDED SYSTEM:(optional) <br /> OS ❑U DS ❑U ®S ❑U ❑S ©U ❑S OU <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: A/g 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 TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B O/ L' ✓YO/U1 7 >? <br /> B- 2. o <br /> B- <br /> Sn Gs <br /> B- /dosr <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 PERIOD2 PERIOD PER INCH <br /> P- S / /Z <br /> P- Alo&iC / 5 J f j <br /> P- <br /> P- <br /> P_ <br /> P_ <br /> PLOT <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 /> S.«;4„d �sc;J .9r1e4' Tcc ZoGd A, aM / /w, 140'6.d;" <br /> � 3t' <br /> TN <br /> G <br /> zo <br /> o w�f <br /> 4-' <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 /> Al /6/ ^— -a--•.e Q — O <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 333/ *2GG - 2- s <br /> CST SIGNAT E <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />