Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, PERCOLATION TESTS 115 DIVISION <br /> 4460R AND P.O. BOX 7969 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> 11 LHR 83.0911) &Chapter 145) <br /> LOCATION: SEICTIO lNOBLK.NO.: <br /> / SUBDIVISION NAME: <br /> 4 %� /R [SE (oW SIPcKSotj <br /> EEK <br /> COUNTY: MAILING ADDRESS: <br /> lP 1 $032 ORAew 1A4 - N - ATIONR 4 <br /> USE DATES OBSERVS ADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: ROF S:❑ / A TESTS:Residence z7 ('�� ]New ❑Replace A _ Q� L�- Iq - 93 <br /> RATING:S=Site suitable for system U=Site unsuitable for system "1 I <br /> Q_tJVENTIONAL: MOUND: I IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDI NG TANK:RECOMMENDED SYSTEM:(optional)S ❑U S ❑U RS Flu ❑S tzU I COIjVENT10t4 -1L <br /> If Percolation Tests are NOT required DESIGN If any portion of the tested area is in the `' <br /> under I. ILHR 83.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: NA <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHESTTO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) <br /> B I E > 0— (a.¢ <br /> V�MS �� �yBNWl3 <br /> B- 2- Sj .(o NONE b- 1 tins <br /> B- 3 % 91.9 NoNe > 75 <br /> t7-'13lln6 <br /> B- `E Z 91. q No Ne ti-$Spas $- 'l2 �Tns <br /> B- 5 Z I.5 o- 6 lryu - Nrns <br /> EI- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-IN HES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RIOD1 P I D2 PERINCH <br /> P- ) o N b <br /> P- 41 S <br /> P- <br /> P_ <br /> p- <br /> P_ <br /> PLOT <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. A/T- <br /> SYSTEM ELEVATION 9U S9 <br /> r ! ' <br /> 100 f� bm Qf. 5,1VA!QG . BLD-Cz <br /> R�� N <br /> _ w <br /> o <br /> Aga � a <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and meth IS CHI Wi iN/ate <br /> Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. �/n/) <br /> NAME (print): - TESTS WERE COMPLETED ON: -/` <br /> )c4)qR!9 1401l 6 - 19 - 93 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 2-7 Uo W E8 i`ER W1. M893 3Q0 1 jis- (o- 9 is <br /> n;..: CST SIGNATURE: <br /> DISTRIBUTION: Original and One copy toLocal RLkheriey�-Property Owner and Soil Tester. <br /> DILHR-SBD6395 (R. 10/83) —OVER — <br />