Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS <br />INDUSTRY, DIVISION <br />LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 <br />HUMAN RELATIONS 1 / MADISON, WI 53707 <br />'.nv /e7 (H63.0911) &Chapter 145.045) <br />II1.•10 <br />�-�/� <br />I�1Residence <br />/1``l�N/E SECTION:p" W <br />OWNSHIP/MUNICIPALITY: <br />LOT NO.:BLK. <br />NO,: <br />SUBDIVISION NAME: <br />7�U <br />2� fo <br />C` <br />A) %T <br />9 <br />CO TY: <br />OWNER'S/BUYER'S NAME: /y� <br />J.- /�/Cl/U <br />MA L NG ADDRESS: <br />- k)/a� 1T. /6,7;)C <br />II1.•10 <br />�-�/� <br />I�1Residence <br />NO. BEDRMS.: <br />COMMERCIAL DESCRIPTION: <br />, f <br />New ❑Replace <br />RATING: S= Site suitahle fnr cvctem 11= Cite uncuitahle fnr cvctem <br />DATES OBSERVATIONS MADE <br />(PROFILE DESCRIPTI NS: PER OLATION TESTS: <br />CON <br />ENTIONAL: <br />S ❑U <br />MOUND: <br />S ❑U <br />IN-GRO ND PRESSURE: <br />[ S ❑U <br />SYSTEM-IN-FlLLHOLDING <br />❑S ICU <br />TANK: <br />❑S�.0 <br />RECOMMENDED SYSTEM: (optional ) <br />C �aa;t;C��r � <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)(b), indicate: �%— ( Floodplain, indicate Floodplain elevation: /v — <br />PROFILE DESCRIPTIONS <br />BORING <br />NUMBER <br />TOTAL <br />DEPTH IN, <br />ELEVATION <br />DEPTH TO GROUNDWATER <br />-INCHES <br />CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br />TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) <br />OBSERVED <br />EST. HIGHEST <br />B- <br />1 <br />9 <br />SNL <br />(Z(�" <br />6 :�11W115- 5_1 i2 " 2 S . " �' 1/, A,77 7, " <br />B 2 <br />1 int' <br />fit' ©" <br />/J'D <br />71 f <br />�5 sus ��' �5 z� ,. s Mr m 7� j, R'F-5 <br />B- <br />lb 2' <br />s <br />P- <br />B- <br />y <br />G �Q- <br />. , <br />f�dK7s�S. 12` /LS 22" P(1_5 iAeTt PP_, <br />P - <br />� 6'' �f= <br />B <br />PERCOLATION TESTS <br />TEST <br />NUMBER <br />DEPTH <br />INCHES <br />WATER IN HOLE <br />AFTERSWELLING <br />TEST TIME <br />INTERVAL -MIN. <br />DROP IN WATER LEVEL -INCHES <br />PERIOD 1 PERIOD 2 <br />RATE MINUTES <br />PERIOD 3 PER INCH <br />P- <br />Q <br />1 r <br />9 <br />9 <br />P- <br />0 <br />10 <br />! <br />P- <br />a <br />0 <br />s <br />P- <br />P- <br />P - <br />7S <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 <br />BM dee <br />Tvv <br />oT.(rrKs <br />�- +�✓Lsh� adt` <br />r TN( 2 _ <br />�t <br />� e <br />ina-� imp <br />I, the undersigned, hereby certify that the soil tests reported on this f rm were made bgrne itt accord res meMo s specifie t e isconsin <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 />iVHwiC 1p 1 CJ I J VvtmC l.U1V1r Lt I LU Vlv :c <br />ADDRESS:CERTIFICATION NUMBER: IPHONE NUMBER (optional): <br />RT (470 Z/zo <br />V ---Z/- I-- Z <br />DISTRIBUTION: Original and one copy to Local Authority, Property Owner acid Soil Tester. <br />ulLH_'-SBL)-639y R. 02 )i - OVER <br />