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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, P.O. <br /> DIVISION <br /> BOX 7969 <br /> LABOR A{ND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> LO IATSECTION: TOWNSHIP/MUNIEFPALITV: NO.:BLK.�ii NO.: SUBDIVISION NAME: <br /> �j �/ /T . ; N/R • �E Ipr)W . . n�- LDT <br /> COU NTV: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> Sze <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMM R IAL DES RIPTION: <br /> ❑ ` r7 ❑ I N STS: <br /> Residence ENew Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FIL L HOLDING TANK:RECOMMENDED SVSTEM:(optional) <br /> ❑S ❑U ❑S ❑U EIS ❑U ❑S EU ❑S DU <br /> S ST EN RATE <br /> IG : <br /> If Percolation Tests are NOT required DESIf any portion of the lot is in the <br /> under s.1-163.09(SHb),indicate: !+ A Floodplain,indicate Floodplain elevation: ,✓ ^) <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GR UN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED E GHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- <br /> B_ <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> FTEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> BER INCHES AFTERSWELLING INTERVAL-MIN. P RIoD1 PERIOD P R PERINCH <br /> _ Z <br /> PP <br /> [PPE—__ <br /> PLAN VIEW: 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 slop. <br /> SYSTEM ELEVATION <br /> I <br /> A +.. <br /> t N <br /> 1 ,!i <br /> LT _ <br /> , <br /> 1 � <br /> 9 ' <br /> he undersigned, hereby certify that the soil aod <br /> reported on this form were made by me in accord with the procedures methods specified in the Wisconsin <br /> iimistrative Code,and that the data recorded he location of the tests are correct to the best of my knowledge and belief. <br /> AE(print : TESTS WERE COMPLETED ON: <br /> .- <br /> RESS: - \ - CERTIFICATION NUMBER: I PHONE NUMBER optional): <br /> CST SIGNATURE: <br /> t( <br /> -Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4t page-Soil Tester. <br /> >�i <br />