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 /> (I LHR 83.0911)& Chapter 145) <br /> LOCATION: SECTION: TOWNSHIP/ i6Z _LT.Y_ OT NO.:BL .NO.: SUBDIVISION NAME: <br /> /, N/WDE (p C3 <br /> CO TV: '/, L C %/ <br /> MAILING ADDRESS: <br /> /r , / S. 6C2, <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PERCOLATION ESTS: <br /> Residence ❑New Replace <br /> /�//lu .176 <br /> r/. �7CJ tel! <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTION L: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ❑S U ❑S �U ❑S ®U EISU S EJUI ZlhdZ22�2 <br /> DESIGN RATE: <br /> If Percolation Tests are NOT required DESIf any portion of the tested area is in the <br /> under s. ILHR 83.0915)161,indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALP HTO R UN DWATER-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 /> /» Q <br /> e/7 45 <br /> El- • /f/7e t/ / /'" S W roof <br /> B /Q. /t/Gf�� 66 Cl (A114 mot r2#''r <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> F EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> i NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p RIODt PERIOD 2 P R 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 '5�10 Xf /"- .50 <br /> I <br /> a . . GTN <br /> o� <br /> M • C/Iee/ <br /> - Brr _ Ami _R <br /> 1, 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) ITESTS WERE COMPLETED ON: <br /> lZkZxe t � 90 <br /> ADDRESS, CERTIFIC TION NUMBER: PHONE NUMBER(optional): <br /> /c feikI �/3 .3583 �/ / /3v9- �G <br /> CST SIGNATURE:'`' ^s//�L�Y'� <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />