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 /> (I LHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: / TOWNSHIP/MUNICIP LITY: LOT NO.:BLK.NO.: SUBBDI ISION NAME: <br /> W 1/ 1) 1/ /Ty6 N/R 6l(or)W 9 k (n A 'V /T P 09 1 <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> �4r� Mf Rtl / 3 F / 4C ��Y ryl <br /> USE DATES ERVATION MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILED RIPTIO S: ER OLATION TESTS: <br /> Residence New ❑Replace y Q ^1'� er/_a 0 _8 <br /> RATING:S=Site suitable for system U=Site unsuitable for system 7 <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE -IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: optional) <br /> Mob ®S ❑u S ❑u ❑S ®u ❑S1Ru (fo �ii/ <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.0915)Ibl,indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORINGTOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COL R, TEXTURE, AND DEPTH <br /> NUMBER DEPlH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON B CK.) <br /> 1 1a ? NorJ -2 o- v "g c, (S �/ , is r BNM1rlr /Iz 7a 'I <br /> B- II g , I / <br /> B,� Lk 11.3 �A If L / <br /> B- J l � I } It It zl <br /> 7 7 <br /> B- d <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 r1PERIOD2 PER PERI <br /> INCH <br /> P- 3 Al t1 S a f��� OOl S/ //... ?- <br /> P- :1- 0 Na a7 23/ a ? 2- <br /> P- 3 f µ O <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 dista ices. Describe what are the hori- <br /> zontal and vertical elevation reference points and show their location on the plot plan. Show the rsurface elevation at all borin Is and the direction and percent <br /> of land slope. u b S <br /> SYSTEM ELEVATION A B M coo <br /> ulla <br /> 4 <br /> J \ <br /> \ TN <br /> 41 y //i <br /> �y <br /> �f <br /> a � <br /> I,the undersigned, hereby certify that the soil tests reported on t is form were made by me in accord with the procedures and m!thods specified 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. <br /> NAME(p )I TESTS WERE COMPLETE ON: <br /> O r4rl C_ R h T _ 0L 0 800 <br /> ADDRESS CERTIFICATION NUMBE PHONrE NUMBER(optionall: <br /> �e sTr ' s IF Y3 lJ P - is <br /> CST ATURE: � <br /> QA Y-Q <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — C <br />