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IOMT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> -AKDIVISION <br /> RAND PERCOLATION TESTS (115) MADISON,B 17� <br /> MAN RELATIONS WI 53707 <br /> (ILHR 83.09(1) & Chapter 145) <br /> LCAT}O SE TION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.NO.: SUBDIVISI NNAM : <br /> I� '/Sc�'% '1 /T N/R 16 E for o aK� 0 2i �A I - <br /> COUNTY: MAI LINU ADDR 5: <br /> U POT 1 7-1-5 CAM0106V PRIU125 s <br /> USE IDATES OBSERVATIONS MADE <br /> NO,BE : COMM R ALDESCRIPTIO <br /> Residence 0 PA <br /> ❑New ❑Replace <br /> RATING:S-Site suitable for system U-Site unsuitable for system O V <br /> ON <br /> V NT NAL: MOUND: IN-GROUNPPR E -IN-FILL OLDI NG TANK:R ECOMM ENDED SYSTEM:(optional) <br /> ❑S [:]U ❑S ❑u ❑S ❑u ❑S ❑u ❑S ❑U u <br /> If Percolation Tests are NOT re uired - DESIGN RATE: If an <br /> q ,n y portion of the tested area is in the <br /> under s. ILHR 83.09(5)(1 indicate: e't I Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALDEPTHT GROU DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED E TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) <br /> B I `dart �oNC 7 $o O - 31 ms � -3llZms 3 � -�oBNms <br /> B- <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> DEPTH , WATER IN HOLE TEST TIME D I WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-MIN. ___ PEHIOO1 PERIODW PERIC1133 PER INCH <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 scala 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 <br /> I I <br /> . n'b <br /> t <br /> VLI r <br /> - - r <br /> t <br /> ust- 1 . <br /> I, the undersigned, hereby cartify 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): ITESTS WERE COMPLETED ON: <br /> (_H Vp 12y,IN3 q - 3 - g8 <br /> ADORE S: CERTIFICATION NUMBER: PHONE NUMBERIoDtional <br /> T� w 548`r3 &740 /s <br /> C IGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester, <br />