Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY:;, DIVISION <br /> LABOR AND <br /> RELATIONS PERCOLATION TESTS (115) MADISON WI53707 <br /> HUMANRE <br /> (H63.09(1) & Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/Mt}fd+6}pflti : LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> �W 1/S41 :) 7/T ON/Rj�E�.W -9W ors AA tj ,✓A <br /> COUNTY: OWNER'S Rb14Q:S NAME: AILING ADDRESS: <br /> 8 v N <br /> AE7r to MY <br /> 11' [ 30'7 SO Alm <br /> C f l7�iP � <br /> USE DATES OBSPAVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DE RIPTIONS: PER OLATION TESTS: <br /> Residence 2 <br /> XNew ❑Replace <br /> RATING:S-Site suitable for system U=Site unsuitable for system <br /> ONVENTI NAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> XS DU ®S Flu ®S ❑U ❑S ©U ❑S U Ci)MMEN <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: /V <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 /> r `Q <br /> B- 3 72 . ' <br /> B- 2 � t <br /> B- '7 2 17 5 <br /> B- t72 S 5Z!B 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 1 PERIOD PERIOD 3 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 ELEVATION <br /> _ - -7� <br /> - o <br /> 00 s I <br /> . I <br /> (. 4_--�Oxj <br /> 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 correctA;W hoof my knowledge and belief. <br /> NAME (print): TESTS WERE COMPLETED ON: <br /> &, <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> CST SIGNATURE: <br /> J <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> `.DILHR-SBD-6395 (R.02/82) —OVER — <br />