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EH1. 15 <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH <br /> P.O. BOX 309 <br /> MADISON,WISCONSIN 53701 <br /> Sc' sec. REPOORT ON SOIL BORINGS AND PERCOLATION TESTS(' <br /> LOCATION: 1/4,SW1/a, Section O , T7ON, R le E-(4r) W,Township or Municipality [�ak`a f , . . <br /> Lot No. , Block No. County h/1 er r <br /> key Subdivision Name <br /> Owner's Name: ((y 0r_ , �/a <br /> Mailing Address: /x gi� yt v�h�/ ucs ° �7 D 30 <br /> TYPE OF OCCUPANCY: Residence Al No. of Bedrooms 7� Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS ._ �_ Tr, PERCOLATION TESTS 9,37'f <br /> SOIL MAP SHEET—_ SOIL TYPE PERCOLATION TESTS <br /> TEST DEPTH I 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_ / zYa/ 5- e1. aove_ - st- / 0 /vote 30 Zy " - /5 <br /> P-2- 7-tin I / /V •4/07e 3CV I- -"y 24 /v1;. <br /> P-3 2_y'' 11 ,ie 4' M& 317 2- Z- fc <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— if <br /> 1,- el said, /ePee fru/ / , 04 te2;9. 4.1 <br /> B— 7 i(411r 4/elle > � �f" b5( 5dimly /oar 16 </day /ea. . <br /> B— ,� gY one > y'r 41 P 5 /2 h,,, /6" e4 64 nj <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil args.) <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. <br /> i I <br /> EMI - aia ■ 111111111111.11111110111. .aaau111 <br /> 1111111111110111111111111EIMAIIIIMMIERMENIMIIIIIIIIIIIIII <br /> 11111111111111111111112111111111_ ���1 555555��� <br /> smauaaa a ai P MI g : S ,11111111111111111111111111111111 <br /> 5 o <br /> ■aa**lra� BI �i EMI uus..aaas <br /> 1111sas//auuauii tt r :o ' 11������11 <br /> ■■ �m■■. t uau ■■auaa■■.IIMII 41 111.1111111111 IIII . NallaINIIIIIII11111111111 I N <br /> 11=1111 <br /> pra e % RE all ' _ :AIIIIIINMMIIIIIIIIIIIIIIIIIIIII <br /> ■ Vi"el? .cb / 1' ■ •, ` 'f I 111:Mill III 11■11111 <br /> ■_ <br /> 1111111/4111111111111 <br /> ' I • � jk: P3 33I + <br /> ■a■■■ <br /> . 9 „, 6- ENE 1 iniill111111111111111111111111 <br /> „ , ME NEN 1 'Pr,P 1 111111111111 <br /> Mall ' IIIi ■11111 I 11111111M. <br /> 3 I l i CrC • • II, " 3 ! I ! I <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 (printA ea. w �� <br /> � V ; @-nsDY1 Certification No. 55 /.5 �Address fN'I , � VV P 1 5f -r i VQ''Sa j`/gc( 3 <br /> Name of installer if known /J <br /> CST Signature 4 <br /> /1"; -,C . .e'),-'1.011""---' <br /> COPY A—LOCAL AUTHORITY <br />