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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, C DIVISION <br /> LABOR ANDBOX 76 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (H63.090)& Chapter 145.045) <br /> LOCATION: SECTION.T(� e TOWNSHIP/ }p��y—Iy LOT NO.:BLK.NO.: SUBDIVIION NAME: <br /> SF 1/ 4 /1 /0 N/R/'/Q (or1W �� 7 <br /> C�jLINTY: �./- OWNE 'S BUYER'S NAME: MAILING ADDRESS: <br /> l7vrryC11 �Qr � T S / S/L -_3 'L S �1Pc/ llrf - <br /> USE DATES OBSERV IONS MADE <br /> �c7 NO.BEDRMS: COMMERCIAL DESCRIPTION: PROFILE DL`�ZRIPTIONS: E ATION TESTS: <br /> Cn Residence 2SNew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system 0 a <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE SYSTEM-IN-Fl LL HOLDING TANK: RECOMMENDED SYSTEM:(optiona1) <br /> ©$ ❑U ®S ❑U �S ❑U ❑S DU ❑SQU c° � Kly <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: 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 /> 0 s ' F� lS gs R nerd s <br /> B- S C r�i � 11 > 70 <br /> B- > ` olCs <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN, PERIODIPERlOD2 P RI PERINCH <br /> P- <br /> P- <br /> P- <br /> P- <br /> P- <br /> PLOT PLAN: Show locatio latio eats efT borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori <br /> zontal and vertical elevatio 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 ,5 <br /> nt�c /�ln� � rlr a <br /> A r� )311 l r / <br /> �ct } Tt` C .S Yt �@.IOC �C• fiF' <br /> 5 4.it <br /> r/rr 2 <br /> _ TN <br /> S�aF�c Cv:lw s �/o rC a • . . �/�f-t.lf:i-f �1 ltl �il <br /> 13 0 <br /> T \ 7 <br /> c lop <br /> I,the undersigned, hereby certify that the soil tests reporte n�this o • Tby 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 ( int): TESTS WERE COMPLETED ON: <br /> co f SIC .� <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> t .�� r L'%.i r c . S` qb �3 y >�s h°66 ` y!s7 <br /> C G TUBE: <br /> y <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DI LHR-SBD 6395 (R.02/82) -OVER - <br />