Laserfiche WebLink
DEPARTMENTOF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY,. DIVISION <br /> 7969 <br /> LABOR AND P.O. BOX <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON,WI 533707707 <br /> (1 LHR 83.0911) &Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> '/ '/q /T N/R E (or)IN JS" Fo,c 60cwnw) <br /> COUNTY: OWNER'S 'S NAME: MAILING ADDRESS: <br /> Ra3VTT ?_ 2Joll, Po5ox10s71 =-A61,--Z 1Z%Q&g W15r- `54`57-) <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMMERCIAL DESCRIPTION: PirlFILE DFrSCRIP IONS: IR OLATION TESTS: <br /> ❑Residence ❑New ❑Replace to 101 187 <br /> RATING:S=Site suitable for system U=Site unsuitable for system l 11 <br /> ONVENTIONAL: IN-GR ROUND-PRESSURE: SYSTEM-IN-FI LL HOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ❑s ❑u ❑s ❑u�❑s ❑u ❑s ❑u ❑s ❑u <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. (LHR 83.0915)Ib),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 EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> O °9'1'[5 j 4"-48" med S. j 48e- -IZeGS 13- z -12 7-12 0-4l-rs')4'I-54'r»edS; S4"--)Z%S <br /> B- °✓ -1Z X12 O-5'r5',5 -Co0' �s',Coo=-)Zt' 19 <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIODi PE RIOD2 PERIOD3 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 /> TN <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 ON: <br /> Ci761ZL1LC �.WIACorJ62 1010 <br /> 916 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> Fb bo,c $9 W ec&%TMl2 W 1 54893 GS 4�1 -4Zgs <br /> CST TUBE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD6395 (R. 10/83) —OVER — <br />