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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS 115 P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,w153707 <br /> IILHR 83.09111 & Chapter 145) #—�O_ _qo� <br /> LOCATION: SECTION: TOWNSHIPlMUNICIPALITY: LOT NO.:BLK NO.: SUBDIVISION NAME: 55EtSx;r'S <br /> F_ '/4 3 J39N/111(oE 1 r MEE o o�No PIaLtf l <br /> COUNTY. MAILING ADDRESS: <br /> USE <br /> iHeIID-ATES OBSERV`ATIONS ADE <br /> NO.BEDRMS.: COMM R IAL DES RIPTION: PROFILE <br /> A TEST <br /> sidS: <br /> __ <br /> LLQace <br /> - �— <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: tN-GROUND-PR RE: SYSTEM-IN-FILL IOL ING TANK:RECOMMENDED SVSTEM:loptionall <br /> ❑ S �lU ❑S �U ❑S U__. 11 MU S ❑U Howi <br /> If Percolation Tests are NOT required DESIGN RATE: If an <br /> d portion is the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL ELEVATION PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, OBSERVED EST, HlHEf__ TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) <br /> B I 50 �.2 40 17 0 `3 Blms 8 rl aum5 I 1 L{�BumS wRclvl�nbtl '{� So B�u>� <br /> B- � �2 9�-3 0 ZZ -1Blms1-2-ZBc1522- GoBNrjswkcmdm*fib-bzBaMs <br /> B- 3 57 7.0 55 D �$l�s `1 IgB►yns Iq 55Bamsuerldn SS-5�SaMsw W <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME I DROP IN WATER LEVEL-INHES RATE MINUTES <br /> E NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 p RI D2 p R 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 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 NA <br /> '— LOWER <br /> a CLRM <br /> DRIVE 8� DG 13-3 <br /> �-► 3� 3 2. •wEfl TN <br /> W PL_ <br /> J <br /> ABM IDO 3dTjDN1 of SI�ItdC, <br /> FIRE Za 2$022 <br /> 1, the un,lersigned, 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 /> Adrninrstrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. <br /> TESTS WERE COMPLETED ON. <br /> /D - 3/ - 90 <br /> [A�DDRESS CERTIFICATION NUMBER: PHONE NUMBER(opironal): <br /> _ -8 7 <br /> CST 5.IGNATURE' <br /> IBUTION: Original and one copy to Local Authority, Property Owner and Sod Tester. <br /> i .SBDb395 (R. 10/83) - OVER - <br />