Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, _ DIVISION <br /> LABOR ANDPERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> ULHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIPIfW.I44QIPALTT'y: LOT FLK.NO.: SUBDIVISION NAME: <br /> FY k Y, Q /T'y/ N/P4 6(.r)Wi <br /> I •I <br /> CQ TY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: 6"�r03 <br /> a 4 f nr �d e n O 'A tj 'e 't !V1 <br /> USE DATES OBSERVATIONS MAIIE <br /> ��� }} <br /> LL NO.BEDRNIS.: COMMERCIAL DESCRIPTION: rF� ESCRIPTIONS: PER TIQN TESTS: <br /> gResidence - WiNew [:]Replacer� k r <br /> RATING:S=Site suitable for system U=Site unsuitable for system / a F� d <br /> CONVENTIONAL: MOUND: IN_ -GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TAN K: RECOMMENDED SYSTEM:(optional) <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)16),indicate: 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. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B / R 0 99, a- o►�e > 8 o S "B[•>.,i s S " !�' d s <br /> a-a 71 47 t1 > >� s rre [ 4»-dr 67 " 1Z•+t <br /> B- $0 9 F, 1 X 10 s"B c .*L-cf 3 '2s " R »� t a/ s <br /> B-y 7 77. 3 > 7 j-- IT Ire t rrk t 67 ",Q I V 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. PERIODI PERIOD PER PERINCH <br /> p- <br /> AILQ 7 <br /> P- <br /> P- Al .s <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. 41 /Aa Te t6 S De 4-s <br /> SYSTEM ELEVATION 19 AJB Nt e o 0 <br /> IP <br /> .S'c q 4 C 3 �, i /�n Bores 'a <br /> / ; q6 .p - - <br /> —pry I <br /> 4 h tes S 0 A�rwrTV►UaT <br /> too B4tJ 4l�-� <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(Pnn TESTS WERE COMPLETED ON: <br /> Q /) IFd- <br /> A U <br /> DRESS: CERTIFICATION UMBER: PHONE NUMBER(optional): <br /> , <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) -OVER - <br />