Laserfiche WebLink
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS <br /> INDUSTRY, DIVISION <br /> LABOR AND VPERCOLATION TESTS (115) P.O. BOX 7969 <br /> HUMAN RELATIONS \ MADISON,WI 53707 <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCATIO�N`: SECTION: O / I TOW O�P���C IPA L��ITY: LOT NO.:B,�K._NO.: SUBDIVISION NAME: <br /> � '4 '/ /T N R 6� (or)W I'Vf�y; N� N <br /> I <br /> UNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: <br /> )RHO ZL CAMP WEBSTEg Wi Sq 8 j3 <br /> USE DATES OBSERVATIONS MADE <br /> NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: <br /> Residence 2- �� New Replace /O _ /jS — � e� <br /> RATING:S=Site suitable for system U=Site unsuitable for system ((�� <br /> CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) <br /> ❑s u r9sau ❑s2u 11s9u ❑sou r� <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 /> BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN, ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) <br /> B-/ 2 q9-7 A/04/E .30 0- 78N ls 7- 30 EA1m2d 3 s 3D- 0 Xe w r',o CMd r <br /> z R f s w d Md r <br /> " n ? 2 r� 0 -% XV4; 8- 2 pa MMd s 2.5-Z$ T?C W M at C/ha1 r <br /> B-� l Zo- 7Z- ;-Fs W 10WCyr d r <br /> B-3 c/g .(, Z o 3Nl5 g-Zg 8AJ MedS Z2�-3„ Ind r <br /> 2 /2 of �'Md r <br /> BGy, 2 o-b 31i /S 6. 2 &141 S 2q - SRc,w/mot c, r <br /> B- <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH <br /> P- 2 N I s I L �g <br /> P- 2 0 Z 3i i b <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 19. 7 Al aM/y"RAD/'/N��'giL/A/Bf�S Gov <br /> C�Biu C��31n/ <br /> 35' <br /> y <br /> TN <br /> — _ C0rt <br /> d <br /> t31�1G �� <br /> �, . L061 <br /> p � <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 (pd'o- <br /> 0: C 71_L STS WERE COMPLETED ON: <br /> N' tr " fy-IfL TE <br /> S / D -dO —� -7 <br /> ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): <br /> � �7 17.rS'-8rPC_ Yts`7 <br /> C G ATURE: ` <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. ` y � <br /> DILHR-SBD-6395 (R. 10/83) —OVER — <br /> _� �•� <br />