Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> CC P.O. BOX 7969 <br /> LABOR AND <br /> HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON,WI 53707 <br /> (H63.090)& Chapter 145.045) <br /> LOCATION: '/ SECTION, ��/R l�� (orl W:TOWN SHIP/&V4AM r/ e�`Wkt*iFY: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> C UNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.:ICOMMERCIAL DESCRIPTION: ��yyII PROFILE DESCRIPTIONS OLATION TESTS: <br /> IPJ Residence Jd New ❑Replace I ?-/ 7 O � 7 -.�y —� '}_ <br /> RATING:S=Site suitable for system U=Site unsuitable for system 77 <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FI LLHOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> Y! ®SSU [S ❑U ❑S go ❑S ®U I Cotia %-/ <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s.H63.09(5)Ib),indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTAL D PTH 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 /> B,t:�, S'J- /C 'O (� r'B � "1, y ' d ') C S.Q , f - <br /> BS it OZ 7 , " A ar /- �, " S <br /> B- - tic > �' }— t • , �, 1 � � ;1 a8 " � �/s <br /> F F F G r X f 1 n/ ®in �s.f TION�TFZ<TS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PERIOD PE PER <br /> INCH <br /> P_ &I 1d O / ! <br /> P- t Q A G <br /> P p f <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 horn <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 �.III, f01 <br /> �r <br /> 7 Ada .. <br /> Qw rNlr f a C f• d <br /> o�C1 ' �rvw� t <br /> ' �trcQ <br /> . , � t p <br /> 30 , x TN <br /> 16 so <br /> r lieR <br /> 44K l'Iy �� fiwr. Rd <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 /> N E IP int: TESTS WERE COMPLETED ON: <br /> ADDRESS: CERTIFI TION NUMBER: PHONE NUMBER(optional): <br /> kAj T b vwtsc _ s A' 3 i � f16 yis <br /> CST IGNA U E: p <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 M.02/82) —OVER — <br />