Laserfiche WebLink
DEPARTMENT OF REPORT 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 /> LOC TION: SECTION: TOl^y/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> Ya NGJ'/ /3 /TyON/RISE In ) ✓�,ye,y,n/ b� N Bcr/ Arl�l� <br /> COUNTY: Ot!js=, ; BUYER'S NAME: MAILING ADDRESS: <br /> L'brrwerr - V- �K 00 UlirD iLG /f�E2% /�0Z /4r/- <br /> USE DATES OBSERVATIONSNi <br /> NO.B MS.: COMMERCIALDESCRIPTION: IPROFILZEE ��TION PER O p7 ESTS: <br /> esidence New ❑Replace // (i �// ��.�/ <br /> n y/�1 ( / <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIO❑N� . M S.DU IN�G S EJ URE: SVS M-IN❑- U HOLDING TFjNK: RECOMM�i��TS��M�tional) <br /> Sol DESIIGN RATE: U S (��U tested <br /> If Percolation Tests are NOT required �•/, If any portion of the tested area is in the <br /> under s. ILHR 83.091511b1,indicate: 1 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. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> 6/15 . <br /> r : rr <br /> B- 2- '1Z S `0 AV & '7 72 S ' S t5k rS, 67" r. do S . <br /> 5S 16 OAC 71y st,51- I4,- rs -3 . 6>r s <br /> B- (uta`. �iy'D` �oaE > 55" F f5ps <br /> B N `r 5.. 5L )3k is . 73 F t3N s <br /> B- <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 PERIOD3 PER INCH <br /> P- rr I 3-7, <br /> P 1 <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 r` Ana0 <br /> ggo � <br /> 3v <br /> 2461 3c sraxn 21' <br /> 1N <br /> Al 1 oe <br /> Nor <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made RSD <br /> 9 p y 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 ( TESTS WER C MPLE ED ON <br /> le : <br /> fiL 17� f <br /> ADDRES ' �� CERTIFICAT N NUMBER: P�NE NUMBER( tional): <br /> 5 i7L7L`�7—t.r.'lYr/ <br /> r C TSI U <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-8395 (R. 10/83) —OVER — <br />