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MADISON,WISCONSIN 53701 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TE <br /> LOCATION: -" w'/<, Alp;<, Section �, T�[N, R I E (or) W,Township or Municipality <br /> Lot No. , Block No. ' = ' � S ^V1 °- 7- County `� M77 <br /> / � Subdivisiion Name <br /> Owner's Name: - C t i4t (N I'll, <br /> Mailing Address: �1- L( 4) e L /) :_ I I ., - d 4 ova: At /M r\ <br /> TYPE OF OCCUPANCY: Residence X No. of Bedrooms._ Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW_ ADDITION_-REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS___LJ_ PERCOLATION TESTS <br /> SOIL MAP SHEET---, SOIL TYPE <br /> PERCOLATION TESTS <br /> TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WTER LEVEL,INCHES RATE <br /> NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL <br /> BER IST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD'2 PERIOD 3 MIN/IN <br /> 1Lc .L. �l <br /> � C' /T - 1 <br /> P It <br /> SOIL BORING TESTS <br /> TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICK QESS, INCHES <br /> NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) <br /> B- <br /> 7.) / 7 7� r/ J' yen T <br /> B— 3 11 I <br /> 77 r <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and square feet of suit ble;ea4, Indicate n ber of squal'e feet f absorption area <br /> needed for building type and occupancy. 'T p i lV d Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> ( J t - <br /> a - <br /> VI - - - - <br /> e ` <br /> - <br /> - N a <br /> f - <br /> ,1Z- - <br /> �- L <br /> l 1 <br /> I <br /> I,the undersigned, hereby certify that the soil tests reported on this forrnrwere 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 (print) 11 IYI S Certification No. <br /> Address I-e f <br /> Name of installer if known VQ_ <br /> COPY A— LOCAL AUTHORITY CST Signature �� <br />