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 /> V1 (H63.0911) & Chapter 145.045) <br /> LOCATION: SECTION: TOW /MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> '/a '/4 /7 /T N/Rt�{E (o�W �ur�ss � <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> L Residence r� A' � kNew ❑Replace I L� _� <br /> L ✓ G'1 O 7 <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: D-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> [IS []U ❑S ❑U ❑IIV-GROUNS ❑U ❑S ❑U ❑S ❑U Pilz["O ' <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s.H63.09(5)(b),indicate: hJ <br /> 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 /> �x i s �7 <br /> B- <br /> B- <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 AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PERIOD3 PER INCH <br /> P- <br /> P- <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 ELEVATION01 <br /> � I N <br /> I <br /> ... } ; <br /> .t <br /> , <br /> z - <br /> , <br /> I <br /> E <br /> [ -- — etrGn • � i <br /> LSc 4J ' <br /> E i <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord 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 the best of my knowledge and belief. <br /> NAME rint): TESTS WERE COMPLETED ON: <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> R 1- 5 q70 30 <br /> CST IGN URE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. / <br /> DILHR-SBD-6395 (R.02/82) —OVER -- <br />