Laserfiche WebLink
DEPARTMENT DFREPORT ON SOIL BORINGS AND I�, SAFETY & BUILDINGS <br /> INDUSTRY, G DIVISION <br /> BOX 76 <br /> LABOR AND PERCOLATION TESTS `115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (H63.09(1) & Chapter 145.045) <br /> LOCATION: SECTION: TOWNSHIP/ UNICIPALITY: OT NO.:BLK.NO.: SUBDI ISION AME: <br /> IS 11t 1 TSF/N/R/5E ( r)W c � / s ! — — PVs ees <br /> COUNTY: OWNS ' UVER'S NAME: MAILING ADDRESS: <br /> RA C hey t /009 ZOT� ✓E, gl ONS MADES f7z`� <br /> USE DATES OBSERVAT <br /> NO.BEDRMS:ICOM MER IAL DESCRIPTI ON: PROFILE DE RIPTIO S:1PERCOLATI ON TESTS: <br /> XResidence _2. .+ I/� XNew ❑Replace 8O <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> CO NVENTIONAL: MOUND:❑� IN-GROOS ❑URE: SVS❑SS TEM-IN-FUL ❑JG®� PLY <br /> R�idfA ECOMMENDED pt�ieonWall <br /> IfPereerr ❑collation TUessts are NOT required IDESIGN <br /> �rRATE: If any portion of the tested area is in the � <br /> under s.H63.09(5)(bl,indicate: k— I,/,I" I Floodplain,indicate Floodplain elevation: Y'/ <br /> /A_ <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLC R, TEXTURE, AND DEPTH <br /> NUMBER DEEPN <br /> DEPTH IN. ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- l / ���/D ii Q 1VE �+ 9.J .y(ii BlOr, S/ T /S'/e.r �Qc�. <br /> B- <br /> B- 3 //0 /O/ IIO V r ! <br /> z " v_ c <br /> B- '� 8 `I9 ~><'! i�OVJC 8`� Same as g Z <br /> B- 5 /�3 Wal, �dI/C �"�/a! s/ Ts/ 20" 6ti s ! 1 " tgw �sf <br /> g 27N C <br /> 13- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PER PER INCH <br /> P- / �S` /0 <br /> P- Z 30 < 3 <br /> P- r, < <br /> P- <br /> P- <br /> P__-7_ <br /> P P_-7_ / %_ / <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distan es. 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 97' pu <br /> nxfd so Y-4 Of &LO <br /> 8-4 /0> cow '2> gM <br /> 13-S <br /> �os <br /> IN <br /> 9- pP, s� <br /> 13Z/ o P-3 - . . . �' `.�D! Cottt�e � �'`pP° ode_ <br /> �rde, <br /> P z p s5 <br /> B-5 cur <br /> sec OFF <br /> 33/ <br /> m2>u - <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 (print): TESTS WERE COMPLETED N: <br /> JOAN Ip r S 6 <br /> �D1�'Q .� //6 /S(e <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> 2 Z 80 K 7S b DOwr2`r tel". 'If -1 24 23-a-I pis 5�8 <br /> CST SIGNAT E: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. LIT <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />