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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND' PERCOLATION TESTS 1115 MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCAT SE TI N: TOWNSHIP/MUNICIPALITY: LOT NO.:BL .NO.: SUBDI ISION NAME: <br /> W'V4 '/ 3Z /Tq6 N/R M(,,)W OAK 6 NA <br /> NKA <br /> COUNTY: WNER'S UYER'S NAME: MAILING ADDRESS: <br /> URtil LE F9 I E L 15 86) 82 13 LMESEZA<656 <br /> USE DATES OBSERVATION MADE <br /> NO.BEDR 0 DESCRIPTION: R S: PERCOLATION TESTS: <br /> Residence 1� I <br /> XNew ❑Replace 7-88 <br /> �- 7 - Cl <br /> RATING:S-Site suitable for system U-Site unsuitable for system <br /> ONVENTI NAL: MOUND: IN-GROUNDPR RE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: optional) <br /> ®S [:]U NS ❑U lZS [:]U ❑S U ❑S U Cody <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> sl �—� If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(1 indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH T0 GROUP DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHES TO BEDROCK IF OBSERVED(SEE ABBRV.ON 8 CK.) <br /> B- ']2 99.7, NoNb > ?z- o-s81Ic Ms 5- 1y bU r1s Z* 87,uf 145 <br /> B- 11 •-3 1r '7 72 a b -ZbBNn1s U-51 es SHIL <br /> B- 3 I' •3 " 7 ?2 0-5 5- 259 7_5-56 QN�s 56-�Ztt6 <br /> B- II .4 > 72— SAME As -Z <br /> B- s q9 5 ?2 0-6 z BN q - N�s `t9-�z6r� s <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. E D1 PERIOD2 R PERINCH <br /> P- S <br /> P- b <br /> P- 1.1 Ah, i i ► 5� <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 dista ces. Describe what are the hori- <br /> zontal and vertical elevation reference Points and show their location on the plot plan. Show the surface elevation�a't`all borin s and the direction and percent <br /> of land slope. ✓ ��r—L 3t. /11= Ol <br /> SYSTEM ELEVATION �� �1 0 $0P-6 ♦ $M OR566F "REV 04K <br /> I - I <br /> LOT LIMES <br /> 51 0 Rom) <br /> 0% <br /> �N <br /> I It <br /> CR aD u51✓ <br /> 1 D I uE <br /> WEI I <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and me hods specified in the Wisconsin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> NAME(prTulint): lAZDf�l GINS TESTS WERE COMPLETED N: <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> wfz5fE-Z W► 159W3 3670 X15-ems- yes <br /> C$S,SIGNATURE: <br /> DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. �I/`ry-/ - G� <br /> DILHR.SBD8395(R. 10/83) -OVER - <br />