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EH 115 <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> DIVISION OF HEALTH,BUREAU Of ENVIRONMENTAL HEALTH <br /> P.O.BOX 309 <br /> MADISON,WISCONSIN 53701 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TE S _ <br /> LOCATION: W/<, J<, Section -7,TION, R J&(or) W,Township or Municipality jQ <br /> Lot No. �, Block No.—, County o�rA ` 1 <br /> n-f�r / t4 subdivision Name <br /> Owner's Name:- / e/-7 L. <br /> Mailing Address: I 9 1 / .10 6 1 4y 1U v i 6 t-i Al If hn - <br /> TYPE OF OCCUPANCY: Residence V No. of Bedrooms Q 4 �noN.: Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW !� ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS '7- aC' ` 7 ;? PERCOLATION TESTS 9'T 7y <br /> SOIL MAP SHEET SOI L TYPE <br /> PERCOLATION TESTS <br /> TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE <br /> NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL <br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> P- Y a 4Il�' 3 I l Q <br /> P <br /> SOIL BORING TESTS ` <br /> TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES <br /> NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) <br /> 7A S <br /> tf [1 30 " Co . See! �Pfl <br /> 181 S/ V <br /> B- <br /> 6 4A 3a " 1s4" I f " sl% sa <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and square feet QQf suitabl�areas. Indicate nu?f,nber of square feet of absorption area <br /> needed for building type and occupancy. S / r F� n r r /Jr d 0 Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> r <br /> Iry <br /> or <br /> p I <br /> -� t <br /> — - - - N <br /> I <br /> T - <br /> I --------- <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 (print) l 6 J-P r 1 C b #I Certification No. �/ 3 <br /> Address \T b <r \i- (� - `11 If Y-3 <br /> Name of installer if known <br /> CST Signature <br /> COPY A— LOCAL AUTHORITY <br />