Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, - G BOX DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOt1C��ATION:` SECTION: /y �.{ TOWNSHIP/Mild PkL+�Y: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> SG '1 AE 1/4 /IWN/R/-<(or FD <br /> COUNTY: O NEH-584"�P a.�-...." " ' MAILIN ADDRESS: <br /> E 1 s7` v M , ssi <br /> USE DATES OBSERVATION MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: ���---���/// PROFI LJ �D RIPT IONS: PER OLL/,,ggTI NTESTS: <br /> esidence /(/Q y>(J New ❑Replace e <br /> RATING:S=Site suitable for system U=Site unsuitable for system - ` <br /> CONVENTIONAL: IMOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> 9S ❑U ZS ❑U XS ❑U ❑S fX(U ❑S mu Caw/ BEDESIGN !8'x3s <br /> If Percolation Tests are NOT required If an portion of the tested area is in the <br /> RATE <br /> under s. ILHR 83.09(5)(b),indicate: ,01— 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 AB BR V.ON BACK.) <br /> B- 9S�33 A641,15 ",;61S4, " 0 w <br /> B- 47 S a NoNff s AV R, d7" <br /> B-3 ZV AS/ A_1A R. POF <br /> B- 9s'sa' A10 Z.;?- 7" s 1 " s Mr. <br /> B 67 fs-,s. N6AIr "a/ S/' SG" s 7 " s <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 PERIO 3 PERINCH <br /> P- 1 'P 3 1 / Y/ <br /> P_ 2 <br /> P- e <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 /> '"be/ SCALE -1 aocK=/O' <br /> �� I_' � <br /> W :�uI- BM-NAIL /NoAK <br /> /sa' -� •sM TREE FL -/oc)' <br /> P,PePosED <br /> V E- 7s HOUSE Q p SOIL 064i1 <br /> o TN <br /> W I d /'rite. 7Es7's <br /> J3�o' <br /> (JELL <br /> no to >Sry <br /> .SKIVE @ FRoM A964 <br /> L/F7' PuM� <br /> NEEDED <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 (print): TESTSW RE MPLETED ON: <br /> A �L 6 <br /> ADDRESS: CERT FI IONNUMBER PHONE NUMBER(optional): <br /> W 3 CS1r _33 -12 <br /> CST SIG RE: <br /> LTf <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. �---- <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />