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EH 115 _ <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> DIVISION OF HEALTH,BUREAU(5F ENVIRONMENTAL HEALTH <br /> P.O. BOX 309 <br /> MADISON,WISCONSIN 53701 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> LOCATION: A)_%,!� Y<, Section /3, TAIN, R L E-far) W, Township orA�articipafttp J 4�!c SO ✓ <br /> Lot No. 5-i , Block No. , #ALF /100n/ //uyA&CR {/i/�,1�eounty I.?04NF77 <br /> Subdivision Name <br /> Owner's Name: R, 1' SS E�N LAND <br /> Mailing Address: l 3� t �y R/C& 7 -ec`L/J / VAI 35_?'23 <br /> TYPE OF OCCUPANCY: Residence No.of Bedrooms 2 Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW ✓ ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS 57— 7 1 PERCOLATION TESTS <br /> SOIL MAP SHEET '9 SOIL TYPE — <br /> PERCOLATION TESTS <br /> TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE <br /> SINCE HOLE HOLE AFTER INTERVAL <br /> NUM- <br /> INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> BER <br /> P-� ;2Y 5 C f3oRE 7-C3 T dA,A / - !� 3 3� 3 <br /> P- Z 3T zl , 112 /)O / 0 3 3 31y 3 <br /> P_ 3 2p 3 3 <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- 72 NO A/C > -7 W/5 c' S <br /> B- .2 7 NeV C > 7y q X74 c s <br /> B- 3 72 NcNr' > 72 y <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and square feet ofujta a areas. Indicate number of s ?are feet of absorption area <br /> needed for building type and occupancy. /�_��— Pg �_eQ A Ai.y GO Indicate scale <br /> or distances. Give horizontal and vertical reference points. ndicate slope. <br /> q o - �L 'J <br /> o E a Si 5 <br /> F � V <br /> L <br /> y I� <br /> N <br /> L <br /> u 7- 9L <br /> A - q1 5,16 = ' <br /> A C, 5 2 <br /> .00 <br /> Vs 61 <br /> E C / <br /> I ,D <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) Z7,0liJARD K' 51146 X6067,( Certification No. SS yl� <br /> Address 2 406)( 2/Z S/RE�tI 7 Yf7 2L.- <br /> Name <br /> Name of installer if known 1/!1 A/ DA/V/Ee 5 <br /> CST Signature <br /> COPY A— LOCAL AUTHORITY <br />