Laserfiche WebLink
DEPARTMENT OFREPORT ON SOIL BORINGS AND SAFETY & BUILDING <br /> INDUSTRY, DIVISIOI <br /> LABOR AND PERCOLATION TESTS (115) MADISON WI 5370 <br /> HUMAN RELATIONS <br /> (ILHR 83.09(1) & Chapter 145) <br /> LOCAr I 9 '/ SECTIO%��O /�/��lor TOWNSHIP/MWIIOYYiii LOT NO.:BLK.NO.: SUB IVISION NAME: <br /> COUNTY: p` R' eUVE NAME: AILING ADDRESS: <br /> USE DATES OBSERVATIONS MADE <br /> �esidence NO BEDRMS.: COMMERCIAL DESCRIPTION: r�w ❑Replace R _ P I S:IPER5`-L T NTESTS: <br /> %I' Lp <br /> RATING:S=Site suitable for system U=Site unsuitable for system <br /> O�/NVVEENTIONAL: MOUND: �]y�- IN-GROUND-PRESSURE: SYSTEM-IN-F II LLLHOLDING�Tj'AA11: R ECOMMENDED SVSTE :(optional) <br /> uJ OU OS [Ji OS � E]S [Jit <br /> Ji �S RU O i0 / <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. HE TO BEDROCK IF OBSERVED(SEE ABBRV.ON BACK.) <br /> 13- 9F <br /> B � lip,S t <br /> B-2 7� gg c <br /> B- 75 7 /7�5 c r 3A C2 <br /> B- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES <br /> NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD PEP 1p D2 R PERINCH <br /> P. <br /> P- p © 1 <br /> P. O /O <br /> P- <br /> P- <br /> P- a /(�(� <br /> PLOT PLAN: Show locations of percolation tesAssI borings and the dimensions of suitable soil areas. Indicate scale or dis antes. Describe what are the In. <br /> zontal and vertical elevation reference points and spa heir location on the plot plan. Show the surface elevation at all bor ngs and the direction and perce <br /> of land slope. <br /> SYSTEM ELEVATION 6 daidyes �i1Dr� r7y <br /> 75' BASE o/' <br /> o <br /> A4 <br /> 1v6_ <br /> L7 - QoI2e ) <br /> i <br /> Q _ [L6-vA7,ofv I I <br /> 1,o7 S;zE <br /> /fro "x loo" <br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and nethods specified in the W isconsi <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 COMPLETE D ON: <br /> ADDRSS: CERTIFICATION NUMB R: PHNE N UMBE RIoptional` <br /> L S. <br /> OD - <br /> C5T6UNAIU11E: n <br /> i <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> DILHR-SBD$395 (R. 10/83) —OVER — <br />