Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND , PERCOLATION TESTS (115) MADISON,WI 53707 <br /> P.O. BOX 7969 <br /> HUMAN RELATIONS <br /> (I LHR 83.0911)&Chapter 145) <br /> LOCATION: / SECTION: pTOWNSHIP/MtINf1e PAffW: OT NO. BLK.NO.: SUBDIVISION NAME: <br /> SS <br /> ES/ ,(1%4 3_5 /T,//N/IY/�/Por /fit l N/ �ft/y — — <br /> c,. 112 T/- �d oQ!( q/Co/ ADDRESS:Q r B/Ul/. S�Illx zler, /17.C/ SOS <br /> USE IDATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IA L DESCR IPTION: A STS: <br /> (%Residence 3 ❑New XReplace // �-// /�� ✓/�/.�/ <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL:IMOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLD ING TAN1:113ECOMMENDED SYSTEM:( tional) <br /> $ ❑U �S ❑U WS ❑U [:]S ®U [:]S EUe1 <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. (LHR 83.09(5)Ib),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALP H TO GROUIN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- / �of a 99•� /t/Oo_ > �a„ O Cv 3 :la"3G"�med•s; „-707" m s <br /> El- 7Ca" /DC7. �'{///O/� > <br /> B- 3 /7& / /� /UGY/e > �(O " �Q/YJe 0-5 <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LV -IN HES RATE MINUTES <br /> f <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 P RI D2 P PERINCH <br /> P. .3o" <br /> 5 3/ 1?Ike <br /> P- <br /> u <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 /> i <br /> ( _ t I <br /> 63 d `off/ <br /> TN <br /> A� ///1� 1 0 <br /> - � 1I <br /> I <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 specified in the Wisconsin <br /> Administrative Cade,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 COMPLETED ON: <br /> ADDRT1aLl �5. / •�. r�-U� ,^? '� u/I CER IFIC?A�OrNUMBER: PHgj E�UM� yp)onall: <br /> CC//OO /�� CLv CST/SIG��NJA`TJUdRJE: Jr C`fi pLYy�_ <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. �. <br /> DILHR-SBD-6395 (R. 10/83) – OVER – <br />