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E[1 1 i 5 Rev.9/78 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> P.O. BOX 309,MADISON,WISCONSIN 53701 <br /> LOCATION:AW_`14,A)A1 %,Section 7 Tyt N,R// E (or)�Township or Municipality Ci`''/.," E~A <br /> Lot No. c- , Block No. /Jc A-,IeQL � y i-'`-`_ AIP, ►!}t County /7,.)rL 9;-7_ <br /> —subdivision Name <br /> Owner's/Buyers Name: L,zecl'Jho) 7- <br /> Mailing Address: 0-A /o 0 O+N�vtii ' G <br /> TYPE OF OCCUPANCY: Residence !/ No.of Bedrooms COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW L REPLACEMENT ALTERNATE SYSTEM—OTHER <br /> OTHER <br /> DATES OBSERVATIONS MADE: SOIL BORINGS Y6f?./ F,I PERCOLATION TESTS f<9//dl <br /> SOIL MAP SHEET NAME OF SOIL MAP UNIT <br /> PERCOLATION TESTS <br /> 4UM <br /> DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE <br /> INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN <br /> 1STWETTED SWELLING INMINUTESPERIOD1 PERIOD2 PERIOD3 3 ' e erz6F hnie 4 <br /> P-S <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 /> TEXT-JRE,MOTTLING AND DEPTH TO BEDRJCK <br /> NUMBER INCHES <br /> OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES <br /> B— `) ' 15775 ;-e" IL S 3 7 l2. � <br /> B- 7-5 42e 1 Z 5 <br /> B- / ,--�"�/L S7 3 7/ '' <br /> B- Cr`/";' is rs � '/2 .3--21A- - s' <br /> B- (I 1b, � T ?�`r /Z 5 <br /> PLA VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and 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. Indicate slope. <br /> Nor <br /> C! <br /> _ s <br /> f ` <br /> N <br /> Ay' <br /> . . <br /> r 'rr ✓ice+ L`. l_+«.__ ........ . <br /> ' I 1 <br /> A,-�- <br /> a i <br /> s <br /> J I m t ➢ <br /> g <br /> E € <br /> I,the undersigend,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods <br /> specified in the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct to the best of my <br /> knowledge and belief.e <br /> Name (print) / ` Certification No. I => — 7 4' <br /> Address P. ^' A l,gloN a > v <br /> Name of installer if known <br /> n...... A 1.. 11 A..aL...:a.. CST Signature 1'Y a,re <br />