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EH' 115 DANE COUNTY .
<br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES ENVIRON:.'ENTA EALTH DE
<br /> t.fkCV DIVISION OF HEALTH,BUREAU OF ENVIRONMENTAL HEALTH Room 31 3F, Ity-County Bldc
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<br /> 2 MADISON,WISCONSIN 53701
<br /> 7 c,,/ REPORT ON SOIL BORINGS AND PERCOLATION TESTS
<br /> , LOCATION:.`E %,514A,Section ,TEN, R 8_ E (,r)-W,Town 6- 'A /C/ - - A
<br /> - Lot No. _ , Block No.= County 009 4/. 0',
<br /> • Subdivision N.me �-
<br /> Owner's Name:. .�Q41 - ,DQ.�� G �., c---.,e - .�/,/c' / • . 4/< /
<br /> Mailing Address: i�Li/��- .� .,i.G/ ®d 1 4rr.=:■, //1/S//Li 5.:17/1
<br /> TYPE OF OCCUPANC : Residence X No.of Bedrooms 1,1/ D-_.- Other
<br /> EFFLUENT DISPOSAL SYSTEM: NEW X ��--- ADDITION REPLACEMENT /
<br /> DATES OBSERVATIONS MADE: SOIL BORINGS 22 4 /d /✓ 7T8 PERCOLATION TESTS N..727/ 2//978
<br /> SOIL MAP SHEET 4o SOIL TYPE �r-2)Z ' . . .s e2
<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 /> P-I/ S� /12e 4.3 8©/2 CA ,46LE. 0 3 /� .y.4
<br /> �' 04 T� 20 / 3 o /6 c3 /(P 3 /G
<br /> 4-4 20 /t1 4 / / . r6 rG
<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 /> B_ . / /0 7 4/04/.,L /2o-f- 7-r7,s:L 8;S-/GL. 6 cst y'e. e; /E'EdsLT'//75
<br /> a 11/ ./ /zo 7` IS7;.s:LSjric.L6; 9, L 8J kEpsL7//sa
<br /> B- 3 /z 0 ./ /a0 ,& TS'7;s:c L7,'Sc.L S L //' ,� /Gc 77//8‘�
<br /> * /'Z/ 1/ /2.0 f 76R;s;ci/D; sL-Lj- .ego sZ 77//991
<br /> B- ' /1/ .1 /204. Ts Sy sib/8;sc..Z6,tcocs'LT//80;
<br /> a /11- . // /2-o.L. TSS�5ILStsia�//jStA/“;Ci/0'GS. 4e 1f-
<br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) ICO SL 77//.? ,j
<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. L/./A/ 0 WA/ Indicate scale , -
<br /> - or distances. Give horizontal and vertical reference points. Indicate slope:
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<br /> I,the undersigned,hereby certify ify that the soil tests reported on this form were made by me in accord with the procedures
<br /> ., and methods specified in the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct
<br /> to the best of my knowledge and belief.
<br /> • Name (print) '--'�-D.� C�4- / ,/7 H 4 _Cert'fi a ion No. J—`— 0 C) 0 7,9
<br /> Address 1l--'i7 6 ... --,:--2./.-- /1147.0/c/1 C //fc,LC, 11//qa/JO,/ Wisc. 6-37/i
<br /> Name of installer if known 04/P/fi0P(*'(7. -
<br /> • CST Signature . G/2 0< 6(.". r ,41444 _.�.
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