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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, �7 /'1 DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECT ON: TOWNS HIP/WUN+GIPAN41': OT NO.:BLK NO. SUBOI I I N A <br /> '/ '4 3 /T`VN/RTE (p /7�ee %nua/5k4) <br /> COVPTY: f, MAI LING ADDRESS: <br /> �CfUKJ{ e 5710/ U//un .&tl �f5L)2'� <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMM R IALDESCRIPTION: A I ESTS: <br /> Residence j �— ❑New %Replac <br /> RATING:S=Site suitable for system U=Site unsuitable for system / <br /> CONVENTIONAL:❑ MOUND: IN GMU I O E: SVOSTEM-IN-FILL OL ING TANK:gECp/�/NDED SYSTEM,O��oDtional) <br /> VU <br /> S CA I <br /> If Percolation Tests are NOT required DESIGN RATE: S U If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL P H T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED H TO BEDROCK IF OBSERVED (SEE ABBR .ON BACK.) <br /> 'Ok <br /> B- / YU" /3B /e; <br /> B- 11' 0 "Ok Bn /s; =5/"Bn 3 tvjG mot czt ' <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> YTEST DEPTH WATER IN HOLE TEST TIME DROP I N WATER L VEL-IN HES RATE MINUTES <br /> f NUMBER INCHES- AFTERSWELLING INTERVAL-MIN. p RIOD1 PERIOD 2 PEF IOD 3 PER INCH <br /> p- Su <br /> P. <br /> P- <br /> P- <br /> P O / <br /> P. <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scaler 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 ill borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION <br /> r- <br /> : <br /> pU <br /> 4 •w�/i •w� N <br /> I <br /> v <br /> I <br /> 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedure 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 COMF LETED ON: <br /> _ <br /> ADDRESS: CERfIPICATION NUMBER: I P ONE VUMBER(optional): <br /> 71-ou/ Aue 6. 6.A c/ems ,r%I 3 '35& 5 ZO - <br /> CST 51 NAT RE: <br /> oe <br /> ppC®L <br /> DISTRIBUTION: Onginal and one copy to Local Authority,Property Owner and Soil Tester. <br /> DI1_HR-SBD8395 (R. 10/83) — OVER — <br />