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EH '115 ' o P4 P•1.741) <br /> y <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVIC VIROTAL4LTH DEPT <br /> • DIVISION OFAIEALTH,BUREAU OF ENVIRONMENTAL HEALTH 313 , City-Co my Bldg. <br /> , ' , • Ok' site- P.O.BOX 309 Ma Wisconsin 53709 <br /> MADISON,WISCONSIN 53701 <br /> �-r REPO ON SOIL BORINGS AND PERCOLATION TESTS /� <br /> LOCATION:S1'<, ,Section�TI,R 1L E(or)W,Township or unicipality� -SK.✓ / y 01 7 r J`r <br /> Lot No._,Block No. V. ' • ' .� o�%County a <br /> .} 'bdivision ame <br /> Owner's Name: Le / (7'� / 0 <br /> //�I Q ' r <br /> Mailing Address: IC f 4- -fu .✓ fir s/ v/-` se'r s C,- <br /> TYPE OF OCCUPANCY: Residence ✓ No.of Bedrooms Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW AU I]ON REPLACEMENT�,/ <br /> DATES OBSERVATIONS MADE: SOIL BORINGS Al�C}7 6 /PFERCOLATION TESTS i'"��f' /ref /9 <br /> SOIL MAP SHEET SOIL TY E <br /> PERCOLATION TESTS <br /> TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE <br /> NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN" <br /> / 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 <br /> 1'' <br /> ee 6orc 6O Le /a V U A/d 3 d - /6 35 <br /> P ° ,, // n I it 6 3. 3 2 <br /> SOIL BORING TESTS <br /> TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,INCHES <br /> NUMBER INCHES OBSERVED ESTIMATED IGHEST (DEPTH TO BEDROCK IF OBSERVEDI <br /> B— A Ix �� firs /0 S',a-L /O SL 7‘4. <br /> 8 It N� /, ID I, /f' r• 6Y„ <br /> B_ I, y e .2 a ao <br /> II _ „ L /. in •, rD <br /> PLAN VIEW (Locate percolation tests,soil •.re holes and suitable soil areas.) <br /> Indicate on the plan the location and square eet of suitable areas. Indicate number of square feet rption area <br /> needed for building type and occupancy. OW dicate scale <br /> or distances. Give horizontal and vertical re erence points.Indicate slope. • <br /> , <br /> t <br /> s( <br /> Se .L4et <br /> �i /ten ` r C. . e <br /> 7r/ 3 W. <br /> 0 ''rc , iPZRIIIIIIIP,MM.PMPAS' <br /> t C1 00V.e <br /> I1ii1I___ t <br /> ill ill • <br /> I�il' �1 gyp• ,r h <br /> I <br /> en 1111111111111riVIE=.1ran.-.-zr. <br /> 2 es <br /> I,the undersigned,hereby certify that the soil tests re.•rted on this form were made by me in accord with the procedures <br /> and methods specified in the Wisconsin Administrativ Code,and that the data recorded and location of test holes are correct <br /> to the best of my knowledge and belief. l ir Name(print) `l N Certifi ion No. - <br /> Address 4641,—, <br /> e a t' y YU/Y,�•z /,3'c <br /> Name of installer if known <br /> CST Signature <br /> COPY A—LOCAL AUTHORITY - - <br />