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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, - - DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> 64v Ler /1 Z (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBD VISION NAME: LOJ� <br /> 545- 1/4 tic 1/ 13 /T3?N/R E ( )W kosK — — <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> (3u2Nf?T D ( f�-S7RDrv) 109'/6 &40Mnv676n/ .v 55-if3 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFI PT NS: LATION TESTS: <br /> Residence b ❑New Replace p �� <br /> RATING:S=Site suitable for system U=Site unsuitable for system G <br /> ONVENTIONAL: MOUND: IINGROUND-PRESSURE -IN-FILL HOLDING TANK: R ECOMM ENDED SYSTEM:loptional) <br /> S ❑U ❑S ®U OS DU OS ®U ❑S l7U _oV"c—u7: NAAC� <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(t indicate: Floodplain, indicate Floodplain elevation: A/O <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 ACK.) <br /> " bdeT031B- 97'o " O " R�5 <br /> l Q� <br /> B- 3 '12e 97. " NouC ( 72" k;' <br /> B- <br /> B- 157- <br /> IB- <br /> TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD P R PER INCH <br /> P- <br /> P- 2 3 � s at <br /> P- u' 10S t <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 all borings and the direction and percent <br /> of land slope. C9dN g, iooC p^ .Sa•JTorr a�SifO a.re <br /> SYSTEM ELEVATION <br /> O 3� <br /> 7 I }/nusE 31C <br /> f I'a I P, <br /> L I i— <br /> Ga1F s <br /> 7/ TN <br /> /s re,r <br /> GwR• DRt UE <br /> n�a <br /> a-7o'o" <br /> I,th undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and m?thods specified in the Wisconsin <br /> Ad nistrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> NAME ( TESTS WERE COMPLETE ON: <br /> kw i - 2 Oslo <br /> ADDRESS: CERTIFICATION N : PHONE NUMBER(optional): <br /> 3 <br /> /3'Vy14AD A✓ '. s 8 0 71S ;2'.141-3509 <br /> C9 -SiPN'ATDR , r <br /> iT <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-63951R. 10/83) —OVER — <br />