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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS <br /> DIVISION <br /> INDUSTRY, BOX <br /> 1_ABI&R ANO PERCOLATION TESTS (115) MADISON WI 53077 <br /> HUMAN RELATIONS <br /> (ILHR 93.0911)& Chapter 145) <br /> LO ATION SECTION: TOWNSHIPMfHNI@YPAt9PP' OT NO.: LK.NO.: SUBDIVISION NAME: <br /> S kj/'PVW1/ 3E /Tg0N/R/S�(or)W W N <br /> C UNTV 0 R B 'S TAME: MAI I D SS: <br /> �� c S n C; S /37X S� Sr.- ✓Q ; <br /> USE DATES OBSERVATIONS MADE <br /> NO. MS: CO M R IAL DE TI N: pt <br /> I Residence ^ ❑New CKK apiece I r+� y0 � DS– �� ,� 0 <br /> CRATING:S-Site suitable for system U=Site unsuitable for system V 01 O <br /> CON ENT ON ,L: MOUND: IN-GROUND-PR -I N-FILL OLDING TANK:gECOMMENDED SYSTEM:(optional) <br /> If Percolation Tests are NOT required DESIGN RATE: I It any portion of the tested area is in the <br /> under s. ILHR 83.0915)(P+1,indicate: Floodplain, indicate Floodplain elevation: <br /> PROFILE DESCRIPTIONS <br /> BORING TOTALDF—PTH R A •1 ER 0 SOIL H HI KNESS,COLOR, TEXTURE, AND DEPTH <br /> NUMBER DEPTH IN. ELEVATION OB V T OCK IF OB EN O E ABBRV.ON BACK.) <br /> B- e Sir L <br /> B- <br /> B- <br /> B_ <br /> - <br /> B-B -- <br /> PERCOLATION TESTS <br /> TEST DEPTH WATER IN HOLE TEST TIME DROP I AT HES RATER INCH <br /> NUMBER INCHES AFTERSWE LLING INTERVAL-MIN. P I D PERIOD <br /> C ' � <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 Kori. <br /> /ortal 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 and slope <br /> SYSTEM ELEVATION __ cIb �r rc • <br /> 1 /� Kit, o <br /> l 4i `f <br /> c • �? rt <br /> TN <br /> I ) � <br /> `\) ,-k- - . Gate eI / Vod 0"` <br /> � w <br /> Qvcct <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 /> t r IT r/t �_ d- f <br /> ADD ESS. T— p CERTIFICATION NUMBER: PHONE NUMBER(optional): <br /> L 'it C _ <br /> CST NA R n <br /> � rQ <br /> DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. <br /> 'LHR-SBD-6395 (R. 10/83) –OVER – <br />