Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, _ DIVISION <br /> LABOR RE . PERCOLATION TESTS (115) P.O. BOX 37969 <br /> 707 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TO SHIP/MUNICIPALITY: LOT NO.:BILK.NO.: <br /> /t/,'1/.5G 1/ as /TVON/R/SE (p Ck�s47 lou/n�h��0 / — G,P f [of e,5117Vo% <br /> CO NTY: OWNER'S BUYER'S NA E: MAILING ADDRESS: <br /> uine7f .�aLr�f ,�ruT �/i7 ,Cbr.scf /G/cuioecf IG 70 <br /> USE DATES OBSERVATIONS MADE <br /> NO,BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCR PTIO S: ER GO LATI ON TESSTSSn <br /> %Residence �' KNew ❑Replace une M, /; (//7e o ,199( <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: R ECOMM ENDED SYSTEM: optional) <br /> ff ❑V zS ❑� S ❑U ❑S �'o/; VenfiDnQ <br /> If Percolalion Tests are NOT required DESIGN RATE: <br /> 4 If any portion of the tested area is in the <br /> under s. ILHR 83.09151(b),indicate: i <br /> i Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COL R, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON B CK.) <br /> B-a 7�" YyJ O-7",B/.s/,' <br /> it/one > 7a <br /> B- /3/ n09 ion �L10nif > ;24 " '5dme W /'? <br /> B- '/ 7- ' `� 7, ,P /UQ17e > 7� <br /> B- S �_'" q7.5 .ria-7e > 7a" <br /> 0-70,6/5/,• 7"-3/047ms; <br /> 13- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHESRATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PERI D PERINCH <br /> P .F 30" a.7e 5 a/V a a% I a <br /> P- a 30" x/o oz Y,&, a ' si>oI a <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 dista ces. Describe what are the hon- <br /> zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borin s and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION C/7 <br /> � /7P,oioY. -773' <br /> o�. <br /> as <br /> A 1 N <br /> B� e1o�. <br /> o� P4�u <br /> oas p ,e ycb.o .3enefirart. <br /> � 0• <br /> s',ea (�� <br /> aii,9 <br /> o erG <br /> A <br /> I,the undersigned, hereby certify that the soil tests reported on this for a 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 N: <br /> k&Xe �?G, /9 <br /> ADDRESS: C RTIFICATIONNUMBER: PHONE NUMBER(optional): <br /> �Co�/SO TGa r/Ate. 5. RD. r�zs k/eba k/I SS X93 3SP3 - <br /> CST SI NATURE; <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. G / <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />