Laserfiche WebLink
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,WI 53707 <br /> 0 LHR 83.0911) & Chapter 145) ��,�7—/ <br /> LOCATION: SECTION: TOWNSHIP/ ICIPALITY: LOT NO.:BLK.NO.: SUB (VISION NAME: <br /> V0/4 ME- '/ /T QN/R I E fpr Sc <br /> COUNTY: O N R'S BUYER'S NAME: M LING ADDRESS: <br /> & ar1r AVrman x c 70 4e XZ <br /> USE DA ES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRTIONS: PERCOLATION TESTS: <br /> Residence 3 //1� New I�Weplace <br /> RATING:S=Site suitable for system U_=Site unsuitable for system <br /> CX S EA . f S. � \\�U� ❑Q E: SYSTEM-INFILL HOLDING TANK: REC()fv1=MENDED 5Y5IP(optional) <br /> S y��fU S ��7JhU (/fLY" /�f�7C�P <br /> u Percolation Tests are NO irk' 'DES( N R E: If an <br /> �� ` y no of the tested area is in the 1v <br /> under s. (LHR 83.09(5) e: �.,� Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORINGWWD <br /> G NDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> > C ,) 11 <br /> it <br /> B -�r, /Vo-h 5 l0 17 el a CJ/51 .2- n <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PERIOD PERINCH <br /> P <br /> P- r WIfYt-Q. e <br /> ; 74 <br /> P- <br /> R <br /> P_ <br /> PLOTPLAN: 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 p roent <br /> of land slope. <br /> SYSTEM ELEVATION 9 7 - S �r —QrR6� � hE 1610 ido <br /> 1 <br /> SIX 1055,0M16 �57/Y- IdJ" <br /> 57 <br /> Ca6%jv Prop <br /> ra �4 b� '**eye levely� <br /> asoord f4JUI'-t &r LL <br /> _ <br /> IN <br /> 3L <br /> .5-ca le //3/0C k, := /D' 1 ,00a� <br /> Bu„l <br /> G✓e�� %s 7 50 -Prom Ic I <br /> 9 <br /> 35' OA-oId 'Dry <br /> '�;:\,c, <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 Wisconsir <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 COMPLETED ON: <br /> : <br /> ADDR SS: CERTIFICATION NUMBER IPHONE NUMBER(optiona <br /> ax <br /> cif D�35 'S <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 />