Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> ),ATI,/ / SEC TIO%���N/R/S�(orIWTOi�SCIP/Jv1SNCIC�IP'ALITY: LOTNO.:BLK.NO.: SUBDIVISION NAME: <br /> CRRUNTY: OW ER'S BUYER'S ry�ME: MAILING ADDRESS: �, <br /> t7krn�e L r 1kn � W-e, bSTvr W / sc. , '_r <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: IPROFILE NS: PERCOLATION TESTS: <br /> esidence ew ❑Replace L �I <br /> RATING:S=Site suitable for system =Site unsuitable for stem / / 1 <br /> CONVENTION MOUND: IN-GROUND-PRESS E: SYSTEM-IN-FI HOLDI TANK: RECOMME[JD�D SYSTEM:(option 1) <br /> ❑S ❑$ ❑$ ❑$ ❑� o �a//I)� T <br /> cl <br /> If Percolation Tests are NOT required DESIGN RATE:SY T MEL If any portion of the lot is in the <br /> under s.H63.09(5)(b),indicate: f Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED E T. r1_G H-EST TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) <br /> B-3 �`cI o 0 Y 5 q r k 7 yeir '' c S <br /> B- G <br /> B- F F ' <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH <br /> P- <br /> P- <br /> P- <br /> P- <br /> P- <br /> P- <br /> PLAN VIEW: 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 slop. <br /> SYSTEM ELEVATION ��•r <br /> S91e/ <br /> 6 <br /> IPA <br /> � TN <br /> TZ C� <br /> CA to <br /> < JFV <br /> , T4 j- <br /> 1, the undersigned, hereby certify that t oil tests r rted on this m e made by in accord with the procedures methods specified in the Wisconsin <br /> Admimistrative Code,and that the data recorde nd the loca . n of the tests co t to t best of my knowledge and belief. <br /> NAMint): / TESTS WERE COMPLETED ON: <br /> 4 c6 I c. c n a ~ <br /> ADD ESS: CERTIFI ATION NUMBER: P NE NUMBER optional): <br /> LLT LsTvr— w/ -kc _ S'Y �� q2 ��6 yes' <br /> CS NN T <br /> 67a <br /> DISTRIBUTION: Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester. <br /> DI LHR-SBD-6395 IN.03/81) <br />