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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATIOO. BOX 76 <br /> N TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> II LHR 83.0811)& Chapter 145) 2 351 <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT N0�BLK.NO.: <br /> wl/St l/ °I /T oN/RISLoole �pcKso� (ooRcaEs <br /> COUNTY: MAI LING ADDRESS: 04Iy <br /> RAS - A ffrs.TL. <br /> USE DATES OBSERV TIONS MADE <br /> �� ❑New ❑Replace 1/0 - Lij 3 - (.p- Z "�c� <br /> STSNOBEDRMS: � �❑Residenc : <br /> RATING:S=Site suitable for system U-Site unsuitable for system <br /> ONVEN I IONAL: MOUND: IN-GROUNDPRESSUR : STEM-IN-FILL OLDING TANK:RECOMMENDED S STEM:(optional)- <br /> ❑S ❑U ❑S ❑U ❑$ ❑� ❑$ ❑� ❑$ ❑U ►J <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the s,Cyt <br /> A <br /> under s. ILHR 83.09(5)(b),indicate: �— floodplain,indicate Floodplain elevation: 1V <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALN <br /> P H TO R UDWATER INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED E TO BEDROCK IF OBSERVED (SEE ABBR .ON BACK.) <br /> o- 'I 311s - 141SP s IN 8 Urns <br /> 131- <br /> B- <br /> B- <br /> 8- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DR IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN- PERINCH <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 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 Ell borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION <br /> t } N <br /> -7 { <br /> r } r <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with th.-pritocedures 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 IN lief. <br /> NAME (print): TESTS WERE COMPLETED ON: <br /> gIr-Hri20 HoPKta_s 6- 7-3 - 94 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBERloptional): <br /> ZI o 14wl 3S WEaS`rcR wl . 94893 300 5-&6• 1IS7 <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-5395 (R. 10183) -OVER - <br />