Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, � DIVISION <br /> LABOR ANDPERCOLATION TESTS (115 P.O. BOX 7969 <br /> HUMAN RELATIONS1 MADISON,WI 537073707 <br /> (ILHR 83.09(7) & Chapter 145) C-Mv L -F <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> 1/ 1/ 2 /T N/R E Io )W Cpm V. N , ( y <br /> COUNTY: D ILING ADDRESS: <br /> 2 R US - <br /> USE DATES OBSERVATIONS MAD <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: OFI S: ATION1T'ESTS: <br /> ❑Residence /j �— _, ❑New Replace �O - Q� 2 - 9y- <br /> RATING:S=Site suitable for system U=Site unsuitable for system ` `J 1 <br /> QN�VENTI❑U . MNS. ❑0 ING" S ❑U E: SY S EA OSC'�U RECOMMENDED cmyetnoNA>!optionall <br /> IfLL�'Peerrllcolation Tests are NOT rage ad D�+E IS G,L�N RATE: IMSEA <br /> any portion of the tested area is in the <br /> under s. ILHR 83.09(5)Ib),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 ES HIGHESTTO BEDRO K IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- l �G q .S on1E > �� <br /> 0- '18 s '1 �L gOfs <br /> B- 2 15- U.O O > `1S 0- 9B16 '7- 95, 84) <br /> B-3 ln(o �`�•5 O > d'$Blf, 8 lob s <br /> B- <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 2 PERINCH <br /> P_ 19 <br /> P. z o s <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 q2__ 9 <br /> T v -_ <br /> I � <br /> I ! <br /> LRKE �.PK IW AIUVN aPoPuaP <br /> Na . <br /> l <br /> qqo� <br /> 3 1 v <br /> I,the undersigne , hereby certify that the soil tests reporteC do this form were made by me in accord with the procedures and methods specified in the Wisconsin <br /> Administrative Cod ,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 /> 1 C RP,12 PidKI 'S - 1t) - q4 <br /> ADDRESS: CERTIFICATION NUMBER: ONE NUM ERloptional): <br /> Z '1 o v� Wk ( eR . S4913 P � <br /> - � - 5 <br /> CST IG ATURE: - <br /> DISTRIBUTION: Original and ooe..copy to Lo.a4Au;AWIty Kropertt Owner and Soil Tester. <br /> DI LHR-SBD-6395 (R. 10/83) —OVER — <br />