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<br /> 'EH 1 1 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DANE COUNT*qq,�,''�
<br /> ` DIVISION OF HEALTH,BUREAU OF ENVIRONMENTAL HEALTH
<br /> NTA itl }TH DEPT
<br /> P.O.BOX 309 Room 313 y C vg.MADISON,WISCONSIN 53701 Madison, n ►
<br /> ��y REPORT ON SOIL®ORINGS AND PERCOLATION TESTS O*�J 0qb, �0O
<br /> LOCATION:,4 E%,. E'G,Section—L,T_tN,R LoE(or)W,.Tooy+w�ship or MLn:eip.Gty iftifAe /VJJy
<br /> Lot No. 6 9.1E3101*No. • . /- A �f t✓ County DOW VV
<br /> Islon fNJammge
<br /> Owner's Name: DD/7 S,/!l/J/ //
<br /> Mailing Address: /-5-66 /CZ Aid//.,n-S1, SU/1 /Ai iP� �.`<.
<br /> TYPE OF OCCUPANCY: Residence f/ No No.of Bedrooms Other
<br /> EFFLUENT DISPOSAL SYSTEM: NEW v AUDITION REPLACEMENT
<br /> DATES OBSERVATIONS MADE: SOIL BORINGS 9cS 78 PERCOLATION TESTS 9/1/71
<br /> SOIL MAP SHEET SOIL TYPE
<br /> PERCOLATION TESTS
<br /> TEST DEMI DE" CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE
<br /> NUM- maim THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
<br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
<br /> P .7d�� See- �O/� I g' /00 30 I /,A /�6" /.: " z82
<br /> P A 23'`. ,/o% 21 Afo j o I " f3�b" 4' 341
<br /> P-3 If' DaI IS No 3 0 /y�/' i7 " //h" )6,6
<br /> 1 SOIL BORING TESTS
<br /> TEST T01FAl DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,INCHES
<br /> NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED)
<br /> 'B_ / ',IN" /2"73, 36"CL, 66"lobss,/
<br /> 2 101" Crap /e/' 6"Ts, Y.?"a, GO" 4ofss,/, B,!
<br /> B- 3 9 " �, 60"(1, .76"cobs./, BQ
<br /> 1 I fl y" 71)dn 'it"et, ..m" - 4 s,/ /
<br /> B_ s 6Y" 24,7 a, 3r''Cobss•Y, 1,
<br /> 6 i:: &rte /Idles 76"«/ Ito"(4.i./ $4'
<br /> 7 P4 IEW (Locate percolation tests,soil bore holes and suit��i a�re �'/ -tea 0'.9""� of.
<br /> Ins etfon the plan the location and square feet of suitable arer cat�Ii t of uareTeet Absorption drat
<br /> needed for building type and occupancy. Indicate scale
<br /> orldIstances. Give horizontal and vertical rgference points.Indicate slope.
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<br /> D/ 9.,4 III i.itiouipo.
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<br /> I,the unde slpned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures
<br /> and meth o pecified in the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct ,,
<br /> to the best p my knowledge a d belief.
<br /> G
<br /> Name(Prime) ,e) ' e/ 9
<br /> ii Certification No. O2
<br /> Address i /V3 /ol &".r ie.%�!l/�/ 2 Lug i
<br /> Name of in6tailer if known rJ-� i I Q��
<br /> CST Signature v 1—
<br /> . COPY A—1:1.004 AUTHORITY
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