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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 /> REPORT ON SOI L BORINGS AND PERCOLATION TESTS <br /> /Name: <br /> Section �,TSN, R:L7.! (ter) W,Township or Municipality S'0 d <br /> County <br /> Subdivision Name <br /> / a �/s►N j�J9 e e IC <br /> Mailing Address: It�) A dt,�Q, kr ID 'a IJ A uA r j / e <br /> TYPE OF OCCUPANCY: Residence — No.of Bedrooms 2 Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS <br /> SOIL MAP SHEET o• SIU - Tya tj IeN SOIL TYPE(:As 'n - hisp7j*_L_ PeaC .Q, <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 MIN/IN <br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 <br /> P1 3� a rb 3 = y� 33 3 <br /> P- b t 0 2 3 <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 /> o� —t i7 <br /> � 15PLA2.` <br /> 30 <br /> (7 <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) <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. V 0 1Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. 17 U 7- 09 4- <br /> ps K I+o _41- <br /> C3 <br /> 41.o y &A b ftt Ae Ho y t <br /> -C Sr JI <br /> o, <br /> 3E aa, 3 a <br /> ti x e.n a <br /> 3 oea o� 60 Q <br /> 2 to F` qp. LG <br /> IF <br /> $ V • I. t <br /> 3 � qt, <br /> � c <br /> R r, 1 70 8. <br /> X Ro s a� <br /> o <br /> b <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 tesf holes are correct <br /> to the best of my knowledge andbbelli�ef". <br /> Name (print) !vu5 a KfjP o e e Certification No. 7 :7 D Y <br /> Address I?rt & "23 00! 6 � � �J c <br /> Name of installer if known <br /> CST Signature 92A <br /> COPY A— LOCAL AUTHORITY r: <br />