Laserfiche WebLink
DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND . - PERCOLATION TESTS (115) MADISON WI 53707 <br /> HUMAN RELATIONS <br /> (1LHR 83.09(1) & Chapter 145) <br /> LOCATION: SECTION: TOWNS H I P/ttR"filt@+PAirl�V: LOT NO.:BLK.NO.: SUBDIVISION NAME: <br /> Sw1/sem, 1/ I /TgON/R/bl(or)W 7Pe�„' <br /> COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: - S'f//0 <br /> USE DATES CIASERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE `kT�Tf6FJ�'. RERZ`6LATIOR�T7: <br /> JI <br /> Residence onL ❑New ®Replace I <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> ONVENTIONAL: MOUND: IN-GROUNDPRESSURE: SYSTEM-IN-F I LLHO LD ING TAN K:R ECOM MENDED SYSTEM:(optional) <br /> ❑s ❑u ❑s ❑u DS OU ❑s ❑u ❑s ❑u <br /> If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the <br /> under s. ILHR 83.091511b),indicate: Floodplain,indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE,AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST- IT—F IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON ACK.) <br /> 1 0- (Pe 04kr O '/.3 Bn S r ' d0 7t C c WMt <br /> B- 1 �' 0 C qzs 7 $ 0 Rr. D a vs" RFS Cos 7c" 0 8e " <br /> B`6 BC<r 6vS •, Cr rS"- r)" JIQC 1. ^-e <br /> B- C/ N I c+ v / f '" I)- if 91 r-)" R Ej s3 s' a 1 r <br /> (a / J"e , Ct b¢J9- /S .4C Cw/wt cr. <br /> B- 6 T.3 tit Ul- I? ", s, • 0/r so " sV"R Fr sY= 8< ` w.. ads <br /> B- <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWEL LING INTERVAL-MIN. PERIOD 1 P RIOD2 I P PERINCH <br /> p- s / j S <br /> P. 0 //7/ <br /> / <br /> P <br /> P_ <br /> PLOT PLAN: Show locations of Ini Borin's and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- <br /> zontal and vertical elevation refere on the plot plan. Show the surface elevation at all borings and the direction and percent <br /> of land slope. <br /> SYS EM ELEVATION �� s t Q !e / "- Yo -C <br /> I I <br /> I TSB � 4 i <br /> x 76 0 #,n- _ Lwr. «e <br /> I <br /> 77 <br /> qs <br /> I <br /> — —� — -I .4 /u Jw _r-e1 6It, .l�mr iso <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 <br /> PLETEl f <br /> p JCA O fM f J6 �7S/ <br /> ADDR ES$: CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> k11 tj T. s 3 >-r<dew <br /> CS N TURF <br /> t <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br />