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DEPARTMENT OF REPORT ON BO SAFETY & BUILDIN( <br /> INDUSTRY, DIVISION <br /> R{; <br /> LABOR AND PEMADISON WI 5307 <br /> HUMAN RELATIONSfiftowwwSSS t_. <br /> L l , I N: OWNSH CCIPALITY: K. SUBDIyISION NAME: <br /> L; ? %s 3 /T`/©rye/s1(.,)w <br /> C LINTY: E <br /> 175tj ADDRESS: <br /> USE B A D 'e ONS MADE <br /> Residence 1 *Mew ❑Raplaq }•�pE <br /> RATING:S-Shia whable for system U-Site urouite6le for gellsos <br /> O©S a�. MN D: IN O� 1 NK• NOED SYSTEM:(optional) <br /> I DIS MTN 991 <br /> ; L. 6✓V <br /> If Percolation Teets are NOT r u ESIGN RATE: <br /> W -- ,: If apyiortion aJl N is in the <br /> under s.H83.0B15)(b),indkats: Fr'-W. in= 11.. . helavation: <br /> BORING TOTAL ove"N"Wrw W&ELEVATION SS,COLOR, TEXTURE, AND D <br /> NUMBER DEPTH IN, SRV.ON BACK.) <br /> B 7�- /c o /-) f, al t > 7� y "Q+ 1s a f yg,r �,F S �� tl <br /> 13- a 7a 2 ilu , �7a 41 .'8,, [S LS s o ' h Fr T <br /> '2) y ,Ba [ s n s Ll RAS v t, <br /> B- 601 LT do lei <br /> s <br /> Y"'Bads <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME RA <br /> NUMBER INCH S AFTERSWELLING INTERVAL-MIN. PER INCH <br /> P- h' C, O a /16 f/ 3 •S' <br /> P. n,' o :, o f e: s_i a si b <br /> P. -j o 0 3 <br /> P- <br /> P. <br /> P- <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indiorte scale or distances. Describe what are the hort <br /> zontal and vertical elevation reference points and show their location on the plot plan. Show the surfed elevation at all borings and the direction and percent <br /> of land slope. <br /> SYSTEM <br /> TION 9716 <br /> ELEVATION <br /> Sckle 71p <br /> ( t <br /> G � h < ' + <br /> rf)Afir t•r <br /> ATV QIt <br /> TN <br /> �7rt- r <br /> At 4i <br /> 'I <br /> _ ---------- <br /> 1, <br /> 1,the undersigned, hereby certify that the soil teats reported on this form wan made by me in accord with the procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the data recorded mad the location of the to ON eorract to the beat of my knewladge and belief. <br /> NAME ( t : /,, COMPLETED ON: <br /> 4 � rtc !\ 0 � n T I- fit- d V <br /> AD RES : CERTIFICATION NUMBER: PHONF NUMBER(optional): <br /> 37 js 7E6 <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Taster. « : <br /> DILHR-SBD-6395 (R.02/82) —OVER — 4s <br />