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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS ` <br /> INDUSTRY, DIVISION f <br /> LABOR AND PERCOLATION TESTS (115) MADISO,WI 53707 <br /> HUMAN RELATIONS <br /> (H63.09(1) & Chapter 145.045) <br /> LOCAT ON: SEC ON: TOWN HIP/MUNI IPALITY: 'LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> /vl1 /�/ /TT N/R11E ( OP y/37i. L . <br /> CORITY: O f ya i(/�S N H/;// MAILING 76 3 /ADDRESS: 'yAl 'VO//1'' r i ri ,e �/.15.3-�"9a , . <br /> USEE/,/, 7 / DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> I R‹sidence ❑New ❑Replace <br /> 1 <br /> RATING:S=Site suitable for system U=Site unsuitable for system , - <br /> CON�TIONAL: MOUND:� IN-GROG D-PRESSURE: SYSTEM-IN-FILCHOLDING T�: RECOMMENDED�T� optional) <br /> l UU SS S I` U S u1J S C 1 P O/✓LZ <br /> If Percolation Tests are NOT required DESIGN RAyTE: If any portion of the tested area is in the /VA <br /> J <br /> under s.H63.09(5)(b),indicate: 3 14 C./EC S_S. Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES 'CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- / sr 11 a�S ,22D s,c/ 30 '' /s 2 <br /> B- Z (0 / / a2v2- // 3vl / ' ,, <br /> B- 3 co " /1 ,72X 3y - " <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 AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH <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 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 /> • <br /> - - - -__ _ 11- _ - ---- <br /> . __._4- T <br /> i ■ — <br /> i-- __.__-_ - ,_-- -- <br /> 1 <br /> 1 I _EL. <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 /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> CST SIGNATURE: <br /> • <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />