Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR ANDPERCOLATION TESTS (115) MADISP.O. BOX 769 <br /> ON WI 537Q7 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATI N: SECT1/R/�E (orIO� TOWNSHIP/MHNl61FA11T-V: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> CO TY: MAILING ADDRESS: <br /> USE DATES OBSERVATIONS MADE <br /> (-/, NO.BED/pMS: COMM R IAL DESCRIPTION: /DESCRIPTIONS:Jn TS: <br /> IX.JResidence r / - ❑New Replace /(!Hf ' ///'S^./ <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTI❑U . Mil �.❑� IN-GROU� O� E: SVS❑TEM-IN-FILL pOLDING TANK: R�On(/�/)�SYSTEM:' optional) <br /> If Percolation Tests areNOT required DESIGN RATE: S U S U%iu // <br /> q If any portion of the tested area is in the <br /> under s. ILHR 83.091511b1,indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALP H T R UN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED HET TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B' � �� P /L�D/ ��i„ - "Ge /,5; �,/"- yam„ <br /> s,' "- // �n meO t<i roof <br /> B 7 �� •�' �/O/x� c� „ OII C73 116/ <br /> B- 9� /t kz-Z�- �� / , )i7' 5 !�/"- 7 me( 3 /,/ mal <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCmrsRATE MINUTES <br /> i NUMBER INCHES- AFTERSWELLING INTERVAL-MIN. PERIOD I P RI O PERINCH <br /> P v ~ <br /> P- f, <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. <br /> -, - — <br /> 1 <br /> `.t _ <br /> j <br /> t, � r__ <br /> +- 1 <br /> -- —1 — I - - - -� <br /> Y � <br /> i <br /> ' I I <br /> tN <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods so!Citied' t kWrpnsin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. pT <br /> se-- �w <br /> NAME (print) ITESTS WERE COMPLETED ON: <br /> /Q:ie x�ir� <br /> ADDRESS: CERTIFICATION NUMBER: P NEU MBER(optionall: <br /> it �/ i��n /1 �z��7 3 - " & <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) — OVER — <br />