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RECLiVED <br /> • ''� i_ WISCONSIN DEPARTMENT OF HEBLJALTH AND SOCIAL SERVICES <br /> t® • DI SCONE N DEPARTMENT <br /> OF -J�F.ENVIRONMENTAL HEALTH MAY 3 0 �g78 <br /> OF P.O. BOX 309 �r,--Itt p►UMBING SECTION <br /> MADISON,WISCONSIN 53T 1 <br /> N SO!L AT ION TESTS <br /> ' - REPORT O BORINGS AND PERCOLS <br /> 1 _ )W,Township '� S'. Q N+ T <br /> 6c Lc l Y, All Section Section �q ,T��N, R _County <br /> LOCATION: ° <br /> Block No._ <br /> �Subdivi e ___------- <br /> Lot No. -- <br /> Owner's Name: <br /> Other <br /> Mailing Address: No of Bedrooms REPLACEMENT <br /> Residence - -- REPLACEMENT - -- <br /> TYPE OF Ct- i_ _ADDITION - — - �.- ' <br /> EFFLUEN. <br /> DISPOSAL SYSTEM: NcW - Zt,� PERCOLATION TESTS <br /> SCIL BORINGS---� -11 ✓�r - —.--- - <br /> DATES OBSERVATIONS MADE: SOIL TYPE�-�- <br /> SOILMAPSHEET -- PERCOLATION TESTS `•EL,INCI-cT <br /> WATER IN TEST TIPdE ROP IN VYAT _ —__( <br /> HOURS INTERVAL <br /> HOLE HOLE AFTER IN MINUTES PERIOD 1 PEF. D 2 PERIOD <br /> TEST DEPTH CHARACTER OF SOIL SINCE ED SMELLING -- - <br /> THICKNESS IN INCHES 1ST WETT <br /> I: NUM- INC ES _. <br /> BER _ <br /> P__ <br /> ! <br /> �— SOIL BORING T-STS <br /> GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKND,_S 'INCHES <br /> TEST �OTDEPTH TO G <br /> AL DEPTH (DEPTH TO BEDROCK IF OBSE'. - �1 <br /> NUMBER INCHES OBSERVED ESTIMATED 41GHEST <br /> 11 B- ISI n ,'i(t. J �7.3�.`�y /• C _� c.p,f'-`+. 'S�___'� <br /> i 9 0r11C' <br /> B 3 - '2 Ncn.. - 3C l L �,�,i� CL �1� :�•T•.3t, "� <br /> 1 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil-arreeas�.)- <br /> Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of a t, :rptian are; <br /> needed for building type and occupancy. <br /> p sV •�AN:C ___ I 1i.. tescale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> • I IA 01 <br /> I <br /> I ' <br /> Q <br /> t <br /> -.. �L r <br /> I I � I <br /> 1-- <br /> _ <br /> e9T <br /> i <br /> i <br /> J7i P tT J) <br /> I <br /> „ o I4- 'WE <br /> 1,th i undersigned,hereby certi`ry that the soil tests reported on this forn-, were made by me in accord with the pr,- edures <br /> and methods specified in the Wisconsin Admini mative Code,and that thr data recorded and I .cation of test hoI^s re correct <br /> -to the best of my knowledge and belief. <br /> Name (print) =-��J� k_, Sl N(�d�©LAR _-Certification No..- S S e--;P/_._. <br /> Address__ 2 LilC1� ."t f 2 S'� iZ!crV 6,11S_ S`•'• -�4---- <br /> Name of installer if known Pc'+iv fir, '6 I€( > <br /> C9T Signature <br />