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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, - DIVISION <br /> LABOR AND PERCOLATICN, MADISON,WI 5377 0707 <br /> TESTS (115) P.O. BD3 <br /> HUMAN RELATIONS <br /> 11 LHR 83.09hi & Chapter 145) <br /> LOCATION: _ - - SECTION: <br /> N/R��/��J�{lo�r)W TOWNSHIP/MAY: LOT NO.:BLK.IqO.: SUBDIVISION NAME: <br /> PE 1/4 <br /> 9t4 r-it <br /> p-e OWN)=.neBU R,S Pe/ 046 MAo c;� D 9ESp I/W✓FAIf /IV/AS'Sog <br /> NN <br /> USE I DATES OBSERVATION MADE <br /> NO.BEDRMS: COMMERCIAL DESCRIPTION: PROFILE A ESTS: <br /> Residence ❑New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system 6 <br /> ONVENTI NAL: MOUND: IN-GROUND -IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ®S ❑U ®S ❑u CSS ❑u ES [90 ❑S ®u ce� <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. I LHR 83.09� I Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTHTOGROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COL R,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION 1OBSERVED EST.HIGHE T TO BEDROCK IF OBSERVED (SSEEE�ABBRV.ON BACK.) <br /> B- <br /> B- <br /> B- <br /> B- <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 PERIOD 2 PERIOD3 PER INCH <br /> P- <br /> P" <br /> P- <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 distar ces. 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 borin s and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION <br /> , <br /> T tN <br /> I <br /> ,Bo�ew- B <br /> wa , <br /> i <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 /> NA (priptl: TESTS WERE CO P TE <br /> U1 <br /> 0 (7,I c (7, <br /> ADDRESS: CERTIFICATION NUMBER PHONE NUMBER(optional): <br /> W �e.b.�-�.L•�. <br /> CS GN TUR E: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHRSBD6395 (R. 10/83) —OVER — <br />