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 /> (H63.09(1) & Chapter 145.045) <br /> LOCATION:.- — SECTION: TOWNSHIP :LOT NO.:BLK.NO. SUBDIVISION NAME: <br /> C' l I/V �7a �S- /T YON/R/9(or)W T C, j—.s� A/A , ,/A <br /> COUNTY: OWNER'S(BUYER;S CAM :� M;IoLINGADDRESS: � <br /> tt 4 <br /> Sr & e f Al V Ah <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> esidence New ❑Replace I-7� :� 3 �Q f <br /> a I <br /> RATING:S=Site suitable for system U=Site unsuitable for system yV <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: OLDING TANK: MMENDED SYSTEM:(optional) <br /> ®S ❑U (k S DU S ❑ IIYS]TEM-IN-FILLH <br /> U S ©U ElRECO <br /> S ®U C U ou L' <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: 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 BEDROCKK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- ) fib 9 Cf if IS- u8 / 11 9 VM 4 <br /> it <br /> B-�- � q t o L 7T <br /> 17 . 7 ? 8 Ilr'6241i r7 r `` e S <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 t —PER D2 PER OD PER INCH <br /> P_ i 3 � v `� <br /> P- d e i C) l s' / 716t <br /> P- r/ <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 ELEVATION <br /> I J- .. _ <br /> FJ <br /> i <br /> : <br /> I <br /> � y I � Qr <br /> - I I <br /> r r� <br /> i <br /> J�i 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 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 /> N (print): TESTS WERE COMPLEJED ON: <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> CST GN T RE: <br /> t <br /> • L <br /> ' <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />