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 /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION:S / SECTIO�T�/ON/R_ Eto TOWNS <br /> 0dilpn(� i41 3�O.:BLK NO.: SUBflu�VISION�NAVE: <br /> COC/NTY::'V/ MAILING ADDRESS: K//-f, <br /> r eX1 Tarr c�.� 6r64 lh,-4 /2?A/ j_ 1 7 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: A I /'���/$ <br /> Residence New ❑Replace �� /�� �JJZ-(' 7 /7� / <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> OWSTI❑Q . MOUNDOS. ❑U INGNS ❑URE: SVS❑TEM-IN-FILL OL❑DING NK: R ECOMMENDED o/7Il&oht'�/.a SYSTEM:(optional) <br /> If Percolation Tests are NOT required DESIGN RATE: SS U If any <br /> UU <br /> q y portion of the tested area is in the <br /> under s. ILHR 83.09151(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL PTH T GROU DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEV(�ATIryON OBSERVED HI HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- / �o�" �}0 . D' 1(1()P,7 /�j�i �i O-5" J5 <br /> B- 7� /7 9. 1 11On1L > 7A O `�',O,E ,87 5; y"'�JO'8� m rd. 5.0710 b7it�mGY�.5 <br /> 11 <br /> B- Y 7`1 /t/01-1J1 > 7�„ <br /> B- 5 Jam" /�- / /C/or�� > 7� SQrne Q5 <br /> B_ <br /> PERCOLATION TESTS <br /> tiTEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> i NUMBER INCHES- AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERI D2 P E R PERINCH <br /> r — l <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 /> i t <br /> oar <br /> tNk6W=/cc)o A&/ /!7 <br /> Q .Am. <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): TE S WERE COMPLETE.P ON: <br /> uri.- 7, 110 <br /> ADDRESS: C TIFICATION NUMBER. PHONE NUMBER(optionall: <br /> _35 3 �n �lcG �3�10 <br /> GSTSIRS SIG ATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. — <br /> DILHR-SBD$395 (R. 10/83) - OVER - .� <br />