Laserfiche WebLink
DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECTION: TOWNSHIPfMH#4WAPA.Ii X- OT N .: .. SUBDIVISION NAME: <br /> /'/SE 1/4 3& /T /R/41 Ip v <br /> CO NTY: MAILING ADDRESS: <br /> ��Pcle �O�fCL -"Dr Ca/rf <br /> USE DATES OBSE VATIONS MADE <br /> NO.BEORMS.: COMMER IA L DESCR I PTION: ATESTS: <br /> (Residence _ New ❑Replace 7 PROF LE DESCRIPTIONS: � "7 / / <br /> RATING:S=Site suitable for system U=Site unsuitable for system q <br /> CON ENTou M_ jV�. Qu IN G[OS ❑U E: SVGS IO L OLDI O�G � . RE a elVf . <br /> 70DED 101 tional)RS — <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 P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPT-H IN. ELEVATION OBSERVED H TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- ,tlOr > 7 <br /> s <br /> � <br /> B- �( G>. / ,t/cry > <br /> B C�S `J` �/CyL > OCo"a- 4' <br /> B- <br /> PERCOLATION TESTS <br /> lTEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD I P RIOD2 PERIOD 3 PERINCH <br /> P 3" mf 3 J' s 7 <br /> P 3611F Z <br /> s <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 sole 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 5 �p <br /> i <br /> i <br /> I , <br /> I, the undersigned, hereby certify that the soil tests reports [on�t i the procedures and methods specified in the Wisconsin <br /> Administrative Code,and that the data recorded and the C3Y� (/JU'/`/-tests are,Lorerf.to the best of my knowledge and belief. <br /> NAME print : CyJ TEST WERE COMPLETED ON <br /> Zl_/ad ?dl;,? <br /> CERTI FICAATT�ORNEP UMBER: PHOfyUMBE R fo tionall: <br /> CST SIGGNNAT IJ3 `/`/ff// X(J <br /> J>� <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SBOE395 IF. 10/83) – OVER – <br />