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DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK NO.: <br /> SW'/SW 3tp /Tqi N/Rn E Io W SwisswEa N to c <br /> COUNTY: MAILING ADDRES . <br /> r✓ o Jo .R1 ER RD- D14 Ngo R <br /> �i 3 <br /> USE DATES OBSER A IONS MADE <br /> NO.BEDRMS.: COMM R IAL DESCRIPTION: PROFILE EES A ESTS: <br /> Residence 2- t� ❑New ❑Replace I I^ '�1 - G1 s1p <br /> RATING:S=Site suitable for system U=Site unsuitable for system lJ sV <br /> CONVENTIONAL: MOUND: IN-GROUND?RESSIhtE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U I ❑S ❑U INA <br /> DESIGN RATE: <br /> If Percolation Tests are NOT required ^ If any portion of the tested area is in the <br /> 9(511 <br /> under s. ILHR 83.0b1,indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST—TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- I 12it-S Nowe > 77— <br /> O-� Bims 6- 12Bnlrru <br /> B- <br /> B- <br /> 13- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> YTEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> i NUMBER INCHES- AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI D2 P R PERINCH <br /> P- <br /> P- <br /> P- <br /> P- <br /> P- —. <br /> P. <br /> PLOTPLAN: 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 q6.'1 SHED <br /> ISO NCP_y J7oT BIti_00-RP QF_U0 VEM t'll <br /> , <br /> weu �uSb . a <br /> N <br /> Q <br /> I <br /> i <br /> 1, 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 /> RICHA 110PK1n15 1 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> ZTUPD 14W y 35 LAXBST�R tA - Sy 893 306 - I <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) - OVER - <br />