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EH_1,15 Aev.9/78 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> P.O. BOX 3/09,MADISON,WISCONSIN 53701 <br /> LOCATION S''/<S_E 7e, Section�'�' q ,T�N,RLre(or)W,Township or Municipality ) QG �S 0 f' <br /> Lot No. , Block No. County 4 h JII* 2t <br /> e <br /> Owner's/Buyers Name: uwlslon am _ <br /> 71. S f. <br /> Mailing Address: a ory 's- l� r1 1 U T r <br /> TYPE OF OCCUPANCY: Residence No.of Bedrooms491- COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER <br /> DATES OBSERVATIONS MADE: SOIL BORINGS 09��`r�8 �' PERCOLATION TESTS W /_S_ r <br /> SOIL MAP SHEET NAME OF SOIL MAP UNIT <br /> PERCOLATION TESTS <br /> TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE <br /> NUM- SINCE HOLE HOLE AFTE INTERVAL <br /> BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> P- <br /> P_ <br /> P- <br /> P- <br /> SOIL BORING TESTS <br /> TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, <br /> TEXTURE,MOTTLING AND DEPTH TO BEDROCK <br /> NUMBER INCHES <br /> OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES �+ <br /> e- II ;:> 702, 1�h O " c.J C SC.it � <br /> 4,*r. ,, rs iot, rG S-C, L <br /> .3 rl t, w y <br /> B- <br /> B- a I I 7JL i, v 4"5,. cSTC �t <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the pl n thecatioand square feet of suitable areas. <br /> Indicate number of square feet of absorption area needed for building type and occupancy ,Indicate scale or distances. <br /> Give horizontal and vertical reference points. IndicAe slope.}- <br /> /6P o z) <br /> 1 U <br /> t- <br /> L,0+-N � <br /> ar �Y +<< r1 t�htar k <br /> Ny3 ®l <br /> S /?e <br /> �V�J CIC(*�4/j•e <br /> g vVFr.cpFs<� c� <br /> I,the undersind,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods <br /> specified in th Wisconsin Administrative Code,and that the data recorded and location of test holes are correct to the best of my <br /> knowledge and elief. �f <br /> Name (print) q +� `' ''' C• C f�,(._ <br /> Ill S Certification No.— <br /> Address— <br /> o.Address 1 V" r -� _ <br /> Name of installer if known -^ <br /> Copy A— Local Authority CST Signature �4 I <br />