Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND - P.O.PERCOLATION TESTS 115 BOX 7969 <br /> HUMAN RELATIONS MADISON,WI 53707 <br /> ���- (ILHR 83.0911) & Chapter 145) <br /> LOCATION: SECOjL�d 1�/N/ Eto TOWN�SjiIP1714 LI-Y: ` / D 1=171(7— <br /> COUNTY <br /> /7 /t/- <br /> CO NTY: SC/,�/1 MA ADDR E rn� vif <br /> -13 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS: COMM R IA DESCRIPTION: IFROATIONTESTS: <br /> Residence 'ZNew ❑Replace <br /> RATING: S=Site suitable for system U=Site unsuitable for system <br /> ON ENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDI NG TANK: REC MMENDED SYSTEM:loptional) <br /> sou �s ❑u r�s ❑u ❑s u ❑sou <br /> If Percolation Tests are NOT required DESIGN RATE: 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 /> BORINGTOTAL P H T GROU DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVEDHIGHEST—TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) <br /> B � h9'' ",5)1,54(114 <br /> El- <br /> " 9�7& "AeI7 <br /> ,u <br /> B- <br /> PERCOLATION TESTS <br /> Y EST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> F NUMBER INCHES- AFTERSWELLING INTERVAL-MIN. PERIOD I P RIOD2 PERIOD PERI CH <br /> P n <br /> P- / <br /> P. // S Z <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 /> ST M ELEVATION 7o/ 14!11�4f <br /> ' <br /> in zlzf_ 61 a" G kir B ch a fere _ <br /> 7 - <br /> t N <br /> ®el °B <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 COMPLETED ON: <br /> /9,20 <br /> AD ESS. _ C ERTIFI CATION NUMBER: P NE UMB (optional), <br /> 5 VIP- <br /> CST SIGNATOR$,: <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. °" y <br /> DI LHR-SBD-6395 IR. 10/83) –OVER – <br />