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 /> V�- (ILHR 83.0911) & Chapter 145) <br /> L ATION: SECTION: TOWNSHIP 46*14O1Pl�ITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> 1/ 1/ � /T O N/ p ,SCO /✓A KA q <br /> COUNTY: OWNER'S 'S NAME: MAILING ADDRESS: <br /> USE IDATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: ��.� PROFILE DES R TIONS: PER OLATION TESTS: <br /> LJResidence w2 L'TNew ❑Replace I 7— ,� 4� —/� O7 <br /> RATING:S=Site suitable for system U=Site unsuitable for system O O <br /> MONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> is ❑U ❑SC9tl ❑SQtl I ❑SQb I ❑S [El I epA r-ioyu <br /> : <br /> If Percolation Tests are NOT required DESIGN RATE / If any portion of 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 DEPTH TO GROUNDWATER-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- l 69� 6 NoAle > 68 D/r eff QCs /,1$ tr <br /> B- e2 (o .� > 6'K D is D C s S-�n <br /> Sema r� <br /> B- 3 7is- <br /> 99 rLl Al 3. 1)/V O <br /> B- 2.6- 99,A Pk ,tz s ar ATA S Gd <br /> B- 89. �' d v 8 Ar le s <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD PERI002 PERIOD3 PERINCH <br /> 0- -3 a r <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 /> TO <br /> I& I <br /> erN `A ' <br /> OA'Ole <br /> tN <br /> • "Arleta <br /> ,BLOC �s A - e[--b,47ioW <br /> ARP4 <br /> /J 90109. <br /> \best <br /> 9° atP <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by md with the procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to tmy knowledge and belief. <br /> NAME (print): TESTS WERE COMPLETED ON: <br /> ,' -4- 7- /6'- 00 <br /> ADD S : CERTIFICATION NUMBER: IPHONE NUMBER(optional): <br /> oZ <br /> CST SIGNATURE <br /> r i <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />