|
EH115 . .
<br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
<br /> DTvrsioik OF HEALTH,BUREAU OF ENVIRONMENTAL HEALTH
<br /> P.O. BOX 309
<br /> MADISON,WISCONSI N 53701
<br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS
<br /> LOCATION: /E/4,SF'/4, Section 2, SN, RME-fcr) Township osationieifier444,7, DC`/.0t)7
<br /> Lot No. , Block No. , County *61LA"wf TT
<br /> _ Subdivision Name
<br /> Owner's Name: EZ-Z;&"7"— ETt�sOA/
<br /> Mailing Address: SA ,/Vey, j t tj, S. 5'Sf3"0/
<br /> TYPE OF OCCUPANCY: Residence X No. of Bedrooms Other
<br /> EFFLUENT DISPOSAL SYSTEM: NEW 2( ADDITION REPLACEMENT
<br /> DATES OBSERVATIONS MADE: SOIL BORINGS //pS-7 PERCOLATION TESTS —/9 - `•' '-`2"
<br /> SOIL MAP SHEET SOIL TYPE
<br /> PERCOLATION TESTS
<br /> TEST DEPTH CHARACTER OF SOIL I HOURS WA i ER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
<br /> NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
<br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
<br /> P-1 JCP <SEE- � �i, C e— r ? 4/® iso % / /, '.-7
<br /> .•
<br /> P
<br /> PSP ft ,, /I Npc3cQ
<br /> P-3 jO v f e3
<br /> ( wo C) l / y /It „Ir
<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 /> B- / 702- g' 72 ,BL L Ts 3, L 2 o, .ft 4/9
<br /> .. 7� 7- g34. L Z. J'L i6, .s'c1 2 .'4 si s'
<br /> B- 6 . - a,k' 41[ L Ts y ,X L / , JC 1'0if 7 9- 7.2, 04 L Ts 3, L 61 Se,[ fi/ SL .£9
<br /> B- '5 7 3- 7 7 $L 4 Is y, 1 /2, .3-6z '61 .1-L 50
<br /> 7 . 7 7 Z— /?L i Is I/ 1 /7 s4 :S/
<br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
<br /> Indicate on the plan the location and square feet of suitable areas. Indicatenumber of square feet of absorption area
<br /> needed for building type and occupancy. ?5-0
<br /> _0 Indicate scale
<br /> or distances. Give horizontal and vertical reference points. Indicate slope.
<br /> I 1
<br /> IONE 1111111.11 1111.1111111111111111111111111. /1 .■■
<br /> Mal All 1111110111111M01111111111111111111111.011111111111111111111
<br /> F2111 ,: e_4: 11111111111111111111111111111111111111111111 - IMEMNIREII
<br /> ... ♦L .'/ 1111111111111111111111111101111111111111M= `,, r tri/
<br /> 2C U, Ti am � � m ,
<br /> OVIIP/- _i 3.. :. :111 ■u I J unsuuuu. . ■
<br /> f RI ■IRS !A 111111111M1111=11111111
<br /> e /• r■. �� MWIS.R■ T N
<br /> MEI111111111111111111111111111111111,21111111111111111111111
<br /> 11111111111111110111111111111111M11111111111111111111111
<br /> ■1MIMI E uuui I� ■uruuuuuuuuu
<br /> ■i sili ; # a ■ urria u. iniummummicsuuu ■uuuuu
<br /> sorr-rommaimi
<br /> am. awrime. imoix - mit .. , amommia
<br /> aim ■P= os _ MEM
<br /> Sl, los i l ! i I 1
<br /> I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures
<br /> and methods specified in the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct
<br /> to the best of my knowledge and belief.
<br /> Name (print) CFC-..4 vic.4.7 3li/e-r Certification No. 6'$- '1/ Jam'
<br /> Address /C + ol- a NtitE-4L LA/CL'; W''5' _c' y'71
<br /> Name of installer if known .V C, ',/inl /e 4 XClf• '/ T.ii 6
<br /> � ' ,p
<br /> COPY A—LOCAL AUTHORITY CST Signature �2p , l /C44.(1)(44./
<br />
|