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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 /> ,�/�- / TW <br /> N,T ON SOUL' O wyJBORINGS AND PERCOLATION TESTS <br /> LOCATIONS,/L'h,Section & , vN, P/ b-foTownship or Municipality_P'F&- f V - <br /> Lot Na. , Block No.—, County _CLuzf�J �'TT <br /> bdivision Name <br /> Owner's Name: / -y/ <br /> Mailing Address: _!C �! [/CE-CJ <br /> TYPE OF OCCUPANCY: Residence —)L— No.of Bedrooms Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW /_ ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS_NEUh PERCOLATION TESTS /YOU. _/97ff <br /> SOIL MAP SHEET SOI L TYPE <br /> PERCOLATION TESTS - <br /> TEST DEPTH CHARACTER OF SOIL HOURS WAT ER IN TESTTIME DROPINWATER LEVEL,INCHES RATE <br /> NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN - <br /> BER 1STWETTED SWELLING IN MINUTES PERIOD 1 PERIOD l PERIOD 3 <br /> P- 1 13y <br /> P-P2, n Nb a 4/'' y y1 <br /> P_3 36 �i ) N0 3 L/ .3 6 <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 /> L Lis 1 L SL -(5R /o CS-G[2 , <br /> 7 L _ `u'3 S "GR -G-9 .55� <br /> 7 ' <br /> PLAN VIEW (Locate percolation[es[ssoil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and square feet of suitable areas. Ind i to number of square feet of absorption area <br /> needed for building type and occupancy. _�.� _ Indicate scale. - <br /> or distances. Give horizontal and vertical reference points. II Ic Slope. <br /> It I <br /> f / T <br /> �4J C <br /> / <br /> �1 Y <br /> C oza� <br /> ,f ♦ 4CYA7iD 11 <br /> a [o r JY:z ��II <br /> lit! <br /> 77 <br /> I,the undersigned, hereby certify that the .it 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[est holes are correct <br /> to the best of my knowledge and belief. _ <br /> Namn /�FG Certification No 5-J ' ya 9 <br /> Address—/-(– r <br /> Name of installer if known <br /> COPY A—LOCAL AUTHORITY CST Signature <br /> - - 1 <br />