Laserfiche WebLink
DEPARTMENTREPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> - <br /> INDUSTRY, DIVISION <br /> LABOR ANDP.O. BOX 7969 <br /> PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: / TOWNSHIP/MUN16WA11IYj: - OT,[JO. BLK.NO.: SUB%IV�ON NAME: <br /> '/ '/ -55—/TV/ 11 /( l to - t Q , u, Ota 4 /�/? <br /> C NTY: MAILING ADDRESS: <br /> �1�171-2 /v ,�j95/ /L/. Z01(1 If-f J7Z711Wa 1`,, 177/lrj S_S0E,� <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRNLS.: COMMER IAL DESCRIPTION: PROFILE-DES`CRIP A ST <br /> ES: <br /> Residence 3 %New ❑Replace <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ON �TI❑� . M ,N��❑� IN GRD�NS ❑� E: SV❑� I®�L ❑�G A� . R� )uE� SYSTEM:(optional) <br /> If Percolation Tests are NOT required DESIGN RATE: ��JJj 77/77/ <br /> If any portion of the tested area is in the <br /> under s. ILHR 83.09(5)(b),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 H TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> 13- / ,t/or�e > 7� <br /> B_ 7a /lP,/p > 6",O,[6^51, G ,�rred.5;35" 7�„/f rr°d.s <br /> PERCOLATION TESTS <br /> YTEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 p PERINCH <br /> P- �y�_ cue .3 s / <br /> P. �-V CYe- 3 <br /> P- <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 9S/• % �� `'U e�c�o/ r there �vfc� <br /> a <br /> tN <br /> i <br /> a Pere; <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), ITESTS WERE COMPLETED ON: <br /> l2/04f &7,� Z"7 / S, 199U <br /> ADDR S CERTIFICATION NUMBER: PH NE NUMBER(optional): <br /> V /03 Ci/eb�� Gc/Z 5���/J' �' 1_5 _ Sal' y <br /> CST SIGNATURE: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> 01 LHR-SBD 6395 (R. 10/83) —OVER — <br />