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WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH /� / 2 CS <br /> P.O. BOX 309 L J /n a <br /> MADISON,WISCONSIN 53701 <br /> �y REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> LOCATION: a Y<,/�C '/<, SectionL, T-VII, 11E4cijW,Township oF-PAvnieipetity 1�/hn } l� 3S- <br /> Lot No. , Block No.—, d, County 13u#W67T <br /> �'' Z <br /> 1? 14xZZ S ,fASea , %�dtvision Name <br /> Owner's Name: F1 <br /> Mailing Address: .R-r- / S'i R LC,V w I 5 <br /> TYPE OF OCCUPANCY: Residence No. of Bedrooms ,2 EACII Other �OLFX <br /> , <br /> EFFLUENT DISPOSAL SYSTEM: NEW 1/ ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS ` '7-2' 7 7 PERCOLATION TESTS 3 _22 - 7 7 <br /> SOILMAPSHEET AJ14 SOILTYPE <br /> PERCOLATION TESTS <br /> TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL,INCHES. RATE <br /> NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL <br /> BER 1STWETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> P ' �/$ EF GJIC& TEST -.DATA / i A!o 10 3rc 3� <br /> P 3� 3 <br /> y� 11 ff If ff2 N C i s Z 3 7( 3?G < 3 <br /> P- 3 �� f t rL it I �Z N d (0 <br /> SOIL BORING TESTS <br /> TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES <br /> NUMBER INCHES OBSERVED ESTIMATED HIGHEST U (DEPTH TO BEDROCK IF OBSERVED) <br /> B- a ell <br /> f y Tv 'C > 8�' / I� 29 CS ,io 51,;?Y /c'.S /9' <br /> B— 2 8* > Fy y r n <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) ' C 0 R r-'ed'''^ �•- ??`y " <br /> Indicate on the plan the location and square feet of Sut able areas. Indicate nurnt� of square feet of absorption area <br /> needed for building type and occupancy.pe,Q l a`' >A rd S:. :7Td/ki-- Indicate scale <br /> or distances. Give horiiz�ontal and vertical reference poin . Indicate slope.rph �/,'�/i'1f12 �iQka�lll F[D <br /> S , <br /> ccs L T T <br /> M > s' V `5 17 ae '- FoxL7- - <br /> �o <br /> ' aS = <br /> ec Ton ,` <br /> ILa Lqi. t N <br /> 10 <br /> NJ�{ l ( 1 3- I u, <br /> ma <br /> L` r K Kip <br /> ( 1 Sl !'c 7`0 vVY <br /> D <br /> F pq <br /> �L f0 e <br /> -- — — 54`l, <br /> re �� • <br /> I, the undersigned, hereby certify 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) Z-_AL1AK1NL, S<•AMW Certification No. S�'- Y2 <br /> Address A'T .Z /AUX -7/2 .ri XxA ' ll.lr� >j:fk72 <br /> Name of installer if known <br /> CST Signature <br />