Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, - DIVISION <br /> LABOR AND PERCOLATION TESTS 115 P.O. BOX 7969 <br /> HUMAN <br /> HUMAN REE LATIONS MADISON,WI 53707 <br /> (H63.09(1) & Chapter 145.045) Sr�7_g <br /> LOCATION: SECTION: OWNSHIPlbN0001,14 LygY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> S'GJ ',W1 / /T3N/R/4(. NA NA NA <br /> COUNTY: OWNER'S 'S NAME: MAILING ADDRE S: <br /> USE DATES OBSERVATIONS MADE <br /> ����- NO.BEDRMS.: COMMERCIAL DESCRIPTION: ,r��, � II PROFI LE DESCRPTION9 ATION TESTS: <br /> �Hesidence 3 ❑New emplace LS `3 O7 �� _ p� <br /> RATING:S=Site suitable for system U=Site unsuitable for system O O <br /> ONVENT 0_NAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FI LLHOLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> C ❑U ❑S ❑S Com- OS E?�If ❑S CoNueNr,`a,YgL <br /> If Percolation Tests are NOT required DESIGN RATE:/ If any portion of the tested area is in the <br /> under s.1­163.09(5)(bl,indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL DEPTH TO GROUP DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTTH IN, EpOLEVATI ON OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 O 3 !o, .Z 6 7 �j — S iZee.0 6 <br /> S t L {o t in <br /> B- 3 to W FY,, `I 7 toel /S T. CS-!°o 3.2 Aea W&, S <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> V <br /> DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> INCHES AFTERSWELLING INTERVAL-MIN. PER DL PERIOD P PERINCH <br /> I/ <br /> i <br /> ,3o !V <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 .'S� <br /> TD/u,TD,lu, OF Lath _ ._. _ i _ , <br /> ESis r'iNG , <br /> >✓®h.e b Po --- Il c Fih'vATr.cN <br /> i � I <br /> •' �s <br /> - -- TN <br /> l l <br /> VAP3_ --- <br /> I _ <br /> f, <br /> I ' rt <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 /> E S / - IF7 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER Ioptionall: <br /> ATi � � � e 7 ys9 /s <br /> CST SIGNATURE: <br /> Af <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R.02/82) —OVER — <br />