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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, - DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON W 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLK.Ni VISION NAME: <br /> % Kill 1% 19 /T N/R/ E (p )W IL P/1 Ag <br /> 3 <br /> OUNTY: MAILING ADDRESS: <br /> 0 50 E A MW 5.'5_q10 <br /> USE DATES OBSERVATIO S MADE <br /> NO.BEDRMS: COMM R AL DESCRIPTION: �qlPROFILE DESCRIII NS:1PERCOLATION TESTS: <br /> Residence �_ y�Jvew ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> C NVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTE(�M-IN-FILL OLDI(N�G TANK:RECOMMENDED SYSTEM (optional) <br /> S ❑U S ❑U ®S ❑U ❑S U ❑S 1�U 1J <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)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALDEPTH TO R UN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,CO OR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVEDE9T7Tr 7HES TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> B- 1 $0 99• (, IJONE > S0 0-Gw IS 6- q o /?- 30 R fs <br /> B-2 Bo <br /> 91. 1 tl 80 0 - /36 -12 Z- 8 7Us <br /> B- 3 72 8.2 I >`IZ 0 -581I5 5-25 -I5 25 - Z fs <br /> B- y So �$ - 1 II > 130 0-lulls Io-20 X Is 20 - so <br /> B- 5 7Z X6. 7 7Z o-i6oBlls - 171ZIs 17 - 7ZZ- 0, s <br /> B- <br /> PERCOLATION TESTS <br /> lTEST DEPTH WATER IN HOLE TEST TIME D I WATER L V - H RAPER INCH ES <br /> f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI D <br /> P- I 0 2 <br /> 15- <br /> P- <br /> P_ <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 dist nces. Describe what are the hori- <br /> zontal and vertical elevation reference points and show their location Gon�thh�el�plot plan. Show the surface elevation at all bori gs and the direction and percent <br /> of land slope. 6I(IGIIJRL ROPLALf,w"I .rl <br /> SYSTEM ELEVATION <br /> I <br /> s3 1n x _ <br /> SCA4E_I1'- 40' <br /> ♦BM'toQ NAL�IN$��SPKUcE •} 2 <br /> PRovossv SRC f� <br /> SIDG Z5�AND <br /> DRIVE. <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and ff ethods 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 COMPLETE ON: <br /> RICA �D f(cPrius � - 2 -SS <br /> ADDRESS: CERTIFICATION NUMBE13 PHONE NUMBER(optional): <br /> �E�sr w� sy 3670 is- <br /> CST S GNATUR <br /> tSTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> IR-SBD-6395 (R. 10/83) —OVER — <br />