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1 � <br /> VUISI'1►hlSltI DI I'AII IAll 111 (11 III AI 111 AND S(ICIA(. SI IIVIcirs <br /> DIVISION Of IWAL I H, BUREAU OF ENVIRONMENTAL HEALTH <br /> P.O. BOX 309 <br /> MADI;0N,WIS(aINSIN !):17111 0 <br /> �HEPO1iI' ON SOIL Holt INciS AND P1 HCOLAIION TEST <br /> LOCATION: S�/r, 'VF- /r, 11inc'lion � , I / , II �� P (n1) W. I milar.I III I In Miluii llIfilll y <br /> n t <br /> Lot No. A— Block NO.------ - - ---_ _ __ - - ----------_ - -------------_ County __6 y r_ _-.�----------- <br /> Q ubdivision Name <br /> Owner's Name: <br /> Mailing Addr C w►) <br /> TYPE OF OCCUPANCY: Residence x No of Bw1fi;nllu <br /> EFFLUENT DISPOSAL SYSTEM: NEW __. ._. n ADDI FION ____. REPLACEMEN'E <br /> DATES OBSERVATIONS MADE: SOILBORINGS- 3 * /S___7__y PERCOLATION TESTS 5'77 __ <br /> SOIL MAP SHEET SOIL TYPE <br /> PERCOLATION TESTS <br /> TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE <br /> CHARACTER OF SOIL I <br /> r��,+= SINCE HOLE HOLE AFTER INTERVAL <br /> INCHES THICKNESS INiNCHES PERID 1 <br /> BER 1ST WETTED SWELLING IN MINUTES O PERIOD 2 PERIOD 3 MIN/IN <br /> _ _ <br /> PI ` - q <br /> P-�L 3 (P 4 N IQ <br /> Pj 30 it ' ` I I f u o /o 6 <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- 76 „ �. �6 -' y ''d 0 T is 'Ir.<. o tea/ S G. 1 c <br /> B (/ ,r y'`5' h T to S._1. 6 b �i�hY'd .Str�t1 0 <br /> PLAN VIEW (Locate nercnlatinntectc coil hnra hnlac and ci!itahla cnil arpas.l <br /> Indicate on the plan the location and square feet su tat6 areas. I 'cafe n mber/°f square feet of absorption area <br /> needed for building type and occupancy. �(� T C `� Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> r r i� <br /> e -r <br /> S , Q n R, <br /> J W 4 - <br /> I <br /> tIN <br /> � aC,e <br /> � i <br /> It <br /> -- tN - — r--4irA p M <br /> O / • 76tj <br /> tre <br /> 1,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 /> 0 C� 1 C 1 f T CT Ij ► h J" Certification No. �1 1 <br /> Name (print) --r- - <br /> Addxess..,...,-Lv----- <br /> Name of Installer if known C � <br /> CST Signature t� <br /> �C!PY A---LOCAL UT1 ORI'i`i r <br /> — <br />