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r�u <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> -DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH <br /> 'Y.G:•B(rX 309 <br /> 11 MADISON,WISCONSIN 53701 <br /> GQe /47" ;—� r ` REPORT ON SOIL BORINGS'AND PERCOLATION TESTS LAKE <br /> `/ Section �,TZZN, RN7E-fm)W,Township oi-Mw+ieipe4ity �RADff <br /> LOCATION: �, —�� - ' <br /> I Lot No. �, Block No— NORTH /61T County R t t R/UE 7T <br /> �� �s/ /�Tbdwlsmn Nair e <br /> Owner's Name:�u SAN Mailing Address: r09 •CGSS' YL 4Iey CAI/ lye S — <br /> TYPE OF OCCUPANCY: Residence No.of Bedrooms 2— Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW ✓ ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOILBORINGS V--2y— 77 PERCOLATION TESTS <br /> SOILMAPSHEET AJA SOIL TYPE <br /> - PERCOLATION TESTS <br /> I TEST OEPM HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHESRATE <br /> CHARACTER OF SOIL SINCE HOLE HOLEAFTER INTERVAL <br /> NUM- INCHES THICKNESS IN INCHES 1STWETTED SWELLING INMINUTES PERIOD 1 PERIOD 2 PERIOD B MIN/IN <br /> BER <br /> P- I r 8 SEE d eR E PEST d�ATr} i Nc l O 3 32 3 3 <br /> P- / 2. Na -1 U 3/G 72 34 3 . <br /> SOIL BORING TESTS <br /> TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES f <br /> NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) <br /> B_ I w.Sg rMo'r <br /> SQ 67 Ai srr 6 X16 . '�-54" s a "6 cs <br /> e-Z s/"fAr mor ,. <br /> sv " V " S - <s <br /> B- 3gC G 7 At mol 1 <br /> G " a" �s L <br /> PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.) _ <br /> Indicate on the plan the location and square feet of quit Ie areas. Indicate number of square feet of absorption area <br /> needed for building type and occupancy. y/O o > Lno Q Su/rA 6�� � I Indicate scale - <br /> ordistances. Give horizontal and vertical reference points. Indicateslope. FOR A 2%-q4/fly FCj> j <br /> - <br /> O _ r TiA , R <br /> c a <br /> 2Gt 1 <br /> ?: f fC S ACD J7 Ai11 FD. . } <br /> sec •✓'AR 1 <br /> S a ; <br /> R nvi <br /> Q4 ' <br /> f. <br /> �• s <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 test holes are correct <br /> to the best of my knowledge and belief. . <br /> Name Ip,mr) 1591-)A R9 Certification No. <br /> Address /Q-7- 2 ''4 Y' 2/ 7 F 'RFn/ //_� ,Q72 - <br /> Name of installer if known e/cd rN — '4 41?9 7 - <br /> CST Signature r�=Y�fllrtle-rllu� <br /> --^�•�-+__I nrel..eIRHORITYs�_ _ __ _ - - -, � <br />