Laserfiche WebLink
DEPARTMENT OF "REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND , P.O. BOX 769 <br /> HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 <br /> (I LHR 83.0911) & Chapter 145) C M V- 13 D. 119 <br /> LOCATIO SECTION: TOWNSHIP/MUNICIPALITY: OT NO.:BLKNO.: SUBDIVISION AME: <br /> W'/ E '4 20 /T N/RITE (p S Kl 3 <br /> COUNTY: MAILING ADDRESS: <br /> URN .3 of 5AVOWSKI 17PIO CO. RC). A WJ�BSltR W►. 5` 893 <br /> USE DATES OBSERVA IONS MADE <br /> NO.BEDRNIS.: COMMER IAL DES RIPTION: PROFILE DES A STS <br /> ;KNew : <br /> Residence 2 ��� New ❑Replace I _ 2D <br /> 2J✓/h _ q I <br /> RATING: S=Site suitable for system U=Site unsuitable for system C lJr <br /> CONVENTIO AL: MOUND: IN-GROUND-PR E: S STEM-IN-FILL OLDING TANK:RECOMMENDED SYSTEM:(optional) <br /> ❑S U S ❑U ❑S U ❑S U ❑S U M0v <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.0915)16),indicate: �.� Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALP H T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED HET TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B- 1 50 ,?.0 BI Inns BNls '17 -•izo'LN15wR,,rn mo <br /> B-2 SO q �•g 0-4134 6- y43NIs yN-SD 1`W-5wRtmikMett <br /> B_3 S 91• 0 SD 0- 6'511& 6-50$NIS 50-$S�P1�swRC-ty _rano t' <br /> B- `f 0K)( ? o—G811s �- �{?FSIs 47- Sa3alswRcmc�moi'f <br /> 8' <br /> PERCOLATION TESTS <br /> } EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LV L-IN HES RATE MINUTES <br /> f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p RI D1 —PERIOD 2 P PERINCH <br /> P- t' 11IG <br /> $ <br /> P- 2 3/ t.� s <br /> P- 3/ f <br /> p-t F 2 1 Y <br /> P- <br /> P- <br /> PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate sole or distances. Describe what are the hori. <br /> zontal and vertical elevation reference points and show their location on the of plan. Show the surface elevation at all borings and the direction and percent <br /> of land slope. <br /> SYSTEM ELEVATION 2 <br /> a <br /> DRI 0& <br /> BLo . t_ Ct co.an.H . TN <br /> I l <br /> �R.o.W. <br /> ORK . R <br /> LAY-E SCAC.E 1'`= (00 <br /> *�M i 4 t l�1l 1N 2$'� oAK <br /> iI <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 theWi lconsin <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 /> ll � <br /> t NAME print TESTS WERE COMPLETED ON <br /> icon) HDPK&s _ - 20 / <br /> ADDRESS: ` CERT fIC TION NUMBER PHONE N MBERIo tions : <br /> i W 3(D <br /> CS G ATU E: <br /> t <br /> DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. <br /> DILHR-SBDF395 (R. 10/83) —OVER — <br />