Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 7969 <br /> HUMAN RELATIONS <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> 4#t tV �n /TO N/R it E,E W <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> 3Jf?A�C77— L7�4A//`A-="� <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATI ON TESTS: <br /> �esidence 4 New El Replace I-,_ <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL. MOUND:EU IN-G � ❑�RE: SYSOTEM-(N-FILL HOOLDING �j:RECOMMENDED SYSTEM:(optional) <br /> If Percolation Tests are NOT required DESIGN RATE:SYSTEM EEL®U If any portion of the lot is in the <br /> under s.H63.09(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. I HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B -3 �� C�� C I�C^ "t_ �? °IZ' T'S (�' S•A r�7 <br /> B `� L J� !� i'�- 7 Z !o T ` �r�1 i-7 <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 PERIOD2 PERIOD 3 PER INCH <br /> P- ( 4-- �_N Lr' i_'--� 11 F, <br /> P- 2, !/;2— <br /> _P_ <br /> P_ <br /> PLANP- <br /> P- <br /> PLAN VIEW: 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 slop. <br /> SYSTEM ELEVATION �- <br /> 'C' C' <br /> \. J!4 T2 <br /> tN <br /> 7 111 <br /> 7A C7. <br /> I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures ods specified in the Wisconsin <br /> Admimistrative 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 /> i t Esti �) /� f�S'C� f 7- <br /> ADDRESS: <br /> ADDRESS: CERTIFICATION-NUMBER: PHONE NUMBER optional): <br /> CST SJSaNATURE: �� <br /> i <br /> DISTRIBUTION: Original-Local Authority,2nd page-Bureau of Plumbing,3rd page-Property Owner,4th page-Soil Tester. <br /> DILHR-SBD-6395 IN.03/81) <br />