Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON,W 5370 <br /> HUMAN RELATIONS 7 <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOW��P/MUNNIICI ALITY: LOT O.:BLK.NO.: SUBDIVISION NAME' <br /> T 3 �/ / /WON/R/51 (p W <br /> COUNTY: OWNER'S/BUYER'S NAME: MAILIN ADDRESS: <br /> fAwn) 'IHKiST E <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMER IAL DESCRIPTION: PROFIL PT ONS: ER OLATION TESTS: <br /> Residence � ❑New Replace I L-',_ L _ ,* <br /> G�7 S- (/ �'7 <br /> RATING:S=Site suitable for system U=Site unsuitable for system _7 O ( 7` <br /> CO VENTIO❑NAL MSI S. oY IN-GROU o URE: SVSOTEM_'Ia LHO❑I S 5QNK: RECOMnEhD EDtSVSTEM:(optional) <br /> SS L��[Y�, /�� U S S r U V/ <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH 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 ABSRV.ON BACK.) <br /> B - �n /D -D 7 7$" it 6 �L TSr " /�aFs _34,' K+-S. <br /> / If <br /> B- (/ " ISN fs. �t <br /> B- 78' sL . cS s�' ►��s Q�-� <br /> B g- IOI, ►� s" �� fs, ` fzr s <br /> B- 78" OD-'e" �� SL.TS Xj" <br /> 13- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODI PERIOD2 {P R PERINCH <br /> P f IS a iT l <br /> P " PIDWE1 n 1 <br /> P_ It 1 15 13 <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 ELE rr <br /> LoeN �+��X FlLwpbG— <br /> gl t <br /> ctlstfu� 24" <br /> I 24 <br /> Nol) r eLL- <br /> r8ti=> � -- <br /> t <br /> Lcy fib„ <br /> I l V° <br /> \7" <br /> .oft <br /> ce r 3 <br /> I V <br /> 07 c <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): TESTS WERE COMPLETED ON: <br /> Qf r t 7 S'- /_/- 49 <br /> ADDRESS: 'CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 44-7f1 I �ti t l l' , 5y83d 7n"= 24,/Z(, <br /> CST IG UR <br /> 2� S <br /> L y / � <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and $oil Tester. '^ <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />