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4 <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES ENVIRO�NIy+if�t`I�TAL HEALTH DEP1 <br /> • :L'.:, DIVISION OF HEALTH,BUREAU OF ENVIRONMENTAL HEALTH GAlLnenCity-County Bldg. <br /> • P.O.BOX 309 Madison, Wisconsin 53709 <br /> MADISON,WISCONSIN 53701 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS n/ <br /> LOCATION: 4k,.$4,Section.L,TLN,R/12 E(or)W,Township or Mwriu atfry Aff 0Oi <br /> Lot No. b {Block No._. County dea.orai <br /> ��� / I Ivls ame <br /> Owner's Name: <br /> U Mailing Address: ../.c-ad & v 4.84..At�44 � /�. <br /> TYPE OF OCCU)lNCY: Residence No.of Bedrooms 9 Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW_ AD ITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS 9A-77e PERCOLATION TESTS 9��6I78 <br /> SOIL MAP SHEET SOIL TYPE <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 <br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> • <br /> P-/ �/4 1 JOLt'd n� i' �a /j /7r• /,�,r s P-1 w,/ '7,/ /(/ , lRF r <br /> P3 p1t <br /> M' i• I* <br /> , SOIL BORING TESTS <br /> TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,INCHES <br /> NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) <br /> e- / ' ift/" /a"Ts, 34"C1, 66"hbss;/31t4X7- G"Ts, V7"CZ, Ga"Co/ s;6 AMP <br /> B- 46"cc, 36• Cobss%/' 6X <br /> „ VS"LL, 36 "cobss., 11 <br /> B-s 2V'/CC, 38" cobs:/, 6R <br /> • <br /> l: Mfr 3L"e-�, VI" cobss,/, 8/ <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area <br /> needed for building type and occupancy. Indicate scale <br /> or distances. Give horizontal and vertical reference points.Indicate slope. s I 0 �R I <br /> *,,_,A ' .._ riff...r...--a.,....airmazismarril <br /> ;1110 , __ _ 1111111151 : 11111 . <br /> rt■■ II■IiII■IIIr■II■IM■M�Zi <br /> VI12rJ Ism am .r■ ria.� <br /> mans uNvirv■■■i■iRiit - <br /> r111"711111111111111111111ffli■■■■■■■111 WP1■■►11 <br /> 1:11111111U111611111111111111 <br /> f N <br /> litigi � ■■■■111■■11 <br /> 'Aram <br /> 1 ■•■1/:111111-i37"711■■1 <br /> rMinWI I_■■i:■:i■11■I■i!1■114 <br /> TIFIR- 7f' 511 -IM/■■1111111■■■■■■■■�1■w <br /> ' iPUIIP!Uli' <br /> ■■III■ iii.■ , U�� ilii�l■/r <br /> I,the undersi9red,hereby certify that the soil tests reported on this form were ma r with the procedures <br /> and methods Pied in the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct <br /> to the best of*knowledge and belief. <br /> Name(print) ' ,-d'E - • Qi Certification No. 902 <br /> Address ire? ,0/1 Ataz .Py Al -- ..i„ Itifi'r <br /> Name of installer if known t 1•s../--'. �• <br /> 1 CST Signature L_ <br /> `,COPY 4—LOCAL IITHORITY ` <br />