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TMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HOMAN RELATIONS <br /> (I LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:aLK.-N9: Sd89FVM3i9NTMME: <br /> —' '/ 3S /T 40N/RISE (p W �RCKSON .5 CsM. 4OL. <br /> COUNTY: MAILING ADDRESS: <br /> $ 7ZIc RRv I-ANGDOk M1AV. s .L • O <br /> USE DATES OBSERVATIO14SMADE <br /> NO.BEDRMS: COMMER IAL DESCRIPTION PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> ❑Residence (�_ New ❑Replace 7- &.) - 92 NA <br /> RATING:S=Site suitable for system U=Site unsuitable for system �j p 'I <br /> O❑sTIILyU . M❑J.mu IN-G❑J �f E: SVQS INUL OIAIJGTAN E1U I ko D11�CE Yighik (optional) <br /> If Percolation Tests are NOT required DE N RATE: If any portion of the tested area is in the yy�� <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: NIT <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GR UN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED ES HE TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> g- I �Z 2-10-2'$oX1=5 2q Barns 2`1-r{ZB�ms <br /> B- Z D-(D$I P)21 G 23 gN WI-5 23 . 3(' BN rn5 w R c M t).rqa <br /> 3b 4- 3S -;_: <br /> g 3 3Z 3 O 0-(9 BIn3 (,- 13 3"Im3 l b 30 8.N Ms v K�WAI•to <br /> g- <br /> g- <br /> g- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I PERI D2 R 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 all borings and the direction and percent <br /> of land slope. ScgL.� Itr= 6O r <br /> SYSTEM <br /> ELEVATION N� �$ �OD �IAI�lu ?r�JACKPINIE <br /> I AIKE <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 metXsp� in � sconsm <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and be . <br /> NAME (print): TESTS WERE COM LE D ON: <br /> 1 CiHAR 0 floPX/p�5 7 - 6 - 92 <br /> ADDRESS: 271('0 t,/ 35 1�1fx35r+= ,;-_,.wf. Sy893 CERTIFICATION ONUMBER: PHONE NU�MLBER�optionall: <br /> CST SIGNATURE: O6 f71 Jf <br /> 1 41 CsvN <br /> Al:Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> \10/83) —OVER — <br />