Laserfiche WebLink
INDUS TMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> HUMAN <br /> AND PERCOLATION TESTS (115) P.O. BOX 7969 <br /> 3707 <br /> HUMAN RELATIONS \ J MADISON,WI 53707 <br /> ►pro::60v-Lo .�w (H63.09(1)& Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BILK.NO.: SUBDIVISION NAME: <br /> '/ '/a /T`// N/R/ ✓oL 9 P 68?6) <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: !/ <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIP IONS: PERCOLATION TESTS: <br /> Residence 4) �"� New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system / O <br /> CONVENTIONAL: MO ND: IN-GR UND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> s ❑u �s au �s ❑u �.s ❑u a s �u coNy���-T�aw,� <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s.H63.0915)(b),indicate: Floodplain, indicate Floodplain elevation: y?/ <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B J �7�I' lr5o'9" tioU� �7" ,� &K7's , Z3z/- RFS l8 `'l3tirS <br /> B 2 (,'l`` ioi,qr, NoA'E ? 6� `' �, - All<rs RF S 2 gNFs <br /> B 6 3 SDI"�`' o�� ✓03 4IL TS ` '- p F 5 5 30UF5 <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 1 PERIOD2 PERIOD 3 PER INCH <br /> P- b !O 3 ;2 a �/ <br /> P- 0JD <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 percenl <br /> of land slope. <br /> SYSTEM ELEVATION62 <br /> 1 "n <br /> ' 74, <br /> Zundersigned, <br /> p1,te 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 (print): TESTS WERE COMPLETED ON: <br /> 0 <br /> ADDRESS: w , CERTIFICATIO,UNUMBER: PHONE NUMBER(optional): <br /> Rt r3 'b a x -170 /� �A U)i S�k3 1p 5 '7 W(36'0 <br /> CS GNAT RE: <br /> Z� <br /> DPSTRIBUTION:Original and one copy to Local Authority,Property Owner acid Soil Tester. <br /> 01L­: SBD-6d95 (R.02/82) OVER — <br />