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11 LLD 11,, ;I ,„
<br /> REPORT ON SOIL BORINGS AND.PERCO'LATION TESTS
<br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
<br /> ' - P.O. BOX 309, MADISON,WISCONSIN 53701
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<br /> LOCATION:____'n,__'/, Section 3 ,T2N,R 19E (or fownship or Municipality .,o4dit '-1*+
<br /> Lot No._ , Block No. County 4 vie/v,e`6
<br /> Subdivision Name
<br /> Owher's/Buyers Name: L-1^L- la-y rt e tA..2.d iv'Al'
<br /> Mailing Address: -,), �.,0 -,r: `, Lill/
<br /> TYPE OE OCCt)PAN(1Y: Residence . No.of Bedrooms COMMERCIAL
<br /> EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTIEf - • ',At
<br /> DATES OBSERVAT IONS MADE: SOIL BORINGS - ,367 YE' PERCOLATION TESTS_ S- 34' --e 0 •,- ', -
<br /> SOIL MAP SHEET NAME OF SOIL MAP UNIT ,
<br /> PERCOLATION TESTS
<br /> TEST HOURS. WATER IN TEST TIME DROP,IN WATER LEVELf 1t� 17 S
<br /> DEPTH CHARACTER OF SOIL u��av M +,. A
<br /> IJ� INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER 'INTERVAL' MIN/IN
<br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 21 PERIOD 3
<br /> P— / .3 l " o 9 55-c /- Li 2 4/7C ,5— i 4/1--- I y 7
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<br /> P- 3e: 6" sot./, .7 /Ye, 6.- i y2. J Ai I 314• ,
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<br /> SOIL BORING TESTS
<br /> 'BEST T TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,
<br /> NUMBER INCHES TEXTURE,MOTTLING AND DEPTH TO BEDROCK
<br /> OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES
<br /> B- ,_ � _41 ' — �`' .i t'r /y50i / Z 1 ' 9* ,✓ ° 5. h cr ,.__I
<br /> B- ,,, a ' r v,-., 7 7-. G I ors r l ce �'ra t<.., c -.,
<br /> P— 3 7 4-'' a 7'7t it //„ i) sns J /4 rfr/�/ f�{/��y'C7 et/!L�i o / �. ,r
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<br /> B— A Y-" fir,. ,4 F; r' g p>^i 6s w d.,-,,, .c .... -
<br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan,the location and squatefeet,df:tiiifa♦i iPt
<br /> Indicate :lumber of square feet of absorption area needed for building type and occupancy .Indicate scale or distance
<br /> Give horizontal and vertical reference points. Indicate slope. ". -
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<br /> I,the undersigend,hereby certify that the soil tests reported on this form were made by me in accord with t e procedures and methods
<br /> specified in the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct to the best of my
<br /> knowledge and belief.
<br /> Name (print) 1 r- a_ r Certification No. SS 3
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<br /> Address ea f' CJ a` �// �, %.ice 5P �
<br /> Name of installer if known
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<br /> Copy C—Property Owner CST Signature '' .,
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