Laserfiche WebLink
DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR ANO PERCOLATION TESTS (115) MADISON,WI 53707 <br /> HUMAN RELATIONS <br /> - (I LHR 83.09(1)& Chapter 145) <br /> LOCATION: SECTION. TO NSHIP/MUNI ALITY: OT NO.:BLK.NO.: SUBDIVISION NAME: <br /> E (p Ciai <br /> CO NTY: MAI LINU A rlSS: <br /> IZIA574�1)(;I_5, 19W _5 6LZ 5 <br /> USE DATES OBSERVATIONS MADE <br /> NO,BEDRMS.: COMMERCIAL DESCRIPTION: TS: <br /> %Residence ❑New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUN6PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> EIS ❑u ❑s ❑u ❑s ❑u ❑s ❑u ❑s ❑u <br /> If Percolation Tests are NOT required DESIGN RATE: I If any y portion of the tested area is in the <br /> under s. ILHR 83.091511b),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 T TO BEDR CK IF OBSERVED(SEE ABBRV.ON BACK.) <br /> B- <br /> B- <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> 1TES7 DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> i NUMBER INCHES AFTER SWELLING INTERVAL-MIN. —PERIOD I PERIOD P PERINCH <br /> P- <br /> P- <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 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 ELEVATION. <br /> I <br /> lie <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 (y�ri�t : TES WERE COMPLETED ON: <br /> l,/c1','e �io�ir� Qrwo'-c /-?, /Woi <br /> ADD ESS: CE TI FI CATION UMBER: PHONE NUMBER(optional) <br /> , uX <br /> CST SIGN TURF: _ <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R, 10/83) – OVER – <br />