Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND P.O. BOX 7969 <br /> HUMAN RELATIONS PERCOLATION TESTS 115) MADISON WI 53707 <br /> (ILHR 83.09(1) & Chapter 145) 65�` 0 0 QLL A y .41S.Mbn <br /> LOCATION: SECTION: TOWNSHIP/MUNI IPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> N/R 16E (o l W U)l S WEsr POR a Z V.- S T <br /> COUN�TY-: MAILI GADDRESS: <br /> USE D ES BSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: X R FI D NS: ER A Z <br /> N TESTS: <br /> Residence n �� L�New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> NVENTIO❑NAL: M�D: ❑— IN-ND -PRESSURE: SYSTEM-IN-FI LL HOLDING TANK RECOMMENDED SYSTEM:(optional) <br /> SS UU S LX�S ❑� 1�]S ❑� EISMU ('dnIUFNTIAnIq( <br /> If Percolation Tests are NOT required DESIGN RATE: <br /> R ^ If any portion is the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: I �i Floodplain, indicate Floodplain elevation: p <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED ISEE <br /> 0oN� gi <br /> ABBRV.ON BACK.) <br /> B- t (Q3b 3 - 3 rsw <br /> 5r 8 <br /> B r u <br /> 8 2- �P(o 6o NONC 0- 7Nw s '7- �}2$rrr'% y2- (D38NMswb" <br /> B-3 b� I�0• NONI 0-b6hRu (x-36 ams 3b SrJms+� SY <br /> 0 0- �Nms r w2cmdxno <br /> O-(oB1Ury1s �[3nNrU 3`1- 6:5 15 ryInnis pJC,r <br /> B `� Z •� NONE CoS� (es 7- rdm W <br /> 0- 15�fr 5 b `tZ.g ms yZ - (,g$r11ms W f <br /> B- <br /> qj.2 O�I� �a� 66 >J w rNRcm mo 5 <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 11012 2 PERINCH <br /> P- o / / <br /> P- Z <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 t e surface elevation at all borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION L40 <br /> IL <br /> &bKAQo WO.K,10 QN6 <br /> N <br /> s <br /> L _ <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and metho specgd in the Wisconsin <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. ... .'. L <br /> NAME (print : TESTS WERE COMPLETED ON: 7• <br /> OP lnl �- lb- �j`Z �18 <br /> ADDRESS: CERTIFICATION NUMBER: IPHONE NUMBER(optional): <br /> 2 &,o w STE I • S-1 3 3670 e <br /> CST IGNATURE: <br /> 1 <br /> 1414 ;o <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DI LHR-SBD-6395(R. 10/83) —OVER — <br />