Laserfiche WebLink
DEPTOF REPORT ON SOIL BORINGS AND SAFETY <br /> INDUSTRY,USfRY, DMS <br /> LABOR ANDPERCOLATION TESTS (115) P.O. BOX 75 <br /> HUMAN RELATIONS MADISON,WI 5370, <br /> (ILHR 83.09(1)& Chapter 145) <br /> LOCATION: SEC ION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK.NO.: SUB [VISION NAME: <br /> /T N/R/ E (or IN <br /> CO NTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> I,� verr I &C 334; 141at6j"Z52 10i W13 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PP OFILE DES RIPTI NS: PERCOLATION TESTS: <br /> Residence 1IkNew ❑Replace 4/7 <br /> 71 <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> OINNVVENTIONAL: MOUND: IN_ -GROUNDPRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTE :(optional) <br /> [6S ❑U ®S ❑� ®S ❑U IMS ❑u I ❑S KU �#ir r r1CKA <br /> If Percolation Tests are NOT required DESIGN RATE: If an - <br /> y porton of the tested area is in the <br /> under s. ILHR 83.09(5)(b),indicate: �f Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL ELEVATION D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,CO OR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON ACK.) <br /> B- fl �-D I NDW r T5 72" diuons 16, M S, <br /> B- ti 7S° o0,a A)D,uE � 7b' 4' S., 61.is, 31 6,u F s 4q' FSN mEbs <br /> B_ 3 Ji of ,D,r ey' 4 a4 7S 57?" No FS ;� ,. Fs <br /> B �4 t Orr 77� .. 40,54. >-b� TS q" 13NFS 4 ' q <br /> B_ 5 rr ldl Olt <br /> r 1 Sk 6R is . SD" ­)ZI`-)PS 3du 610 MED s <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 PER INCH <br /> P- <br /> P- <br /> P_ <br /> PLOT <br /> -P- <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or dista ices. 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 ELEVATION97 6" <br /> —..-- ----- 3 -30 <br /> S7e.tgeF CNdroc <br /> fib' ¢gra <br /> r <br /> be-17''' cat r <br /> � I � dP1,4CC�r•• 6` 1 <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and me hods specified in the W s nsin <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)' /J TESTS WERE COMPLETED N: <br /> ADDRESS: A�/D t _ D/ fJ IQ� A/' <br /> % % ' ` CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> Cif/C✓ ( .J �' _�.__ 2Y�/-S'S <br /> CS SI T. <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHRSBD-6395 (R, 10/83) —OVER — CCC <br />