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EH 115 " <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> DIVISION OF HEALTH,BUREAU aF ENVIRONMENTAL HEALTH <br /> P.O. BOX 309 <br /> MADISON,WISCONSIN 53701 <br /> 6;Ob/�T 7 REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> LOCATION: Section L,T&N, R L [(M) W,Township o"41hm"+&pafrry j/7 C K SOS <br /> Lot No. 5Y Block No. , &41-6 /YIOL'A/ UuyAErR !�/��6sounty 1304NE77 <br /> Subdivision Name <br /> Owner's Name:kv SS' NG�ELANIoa <br /> Mailing Address: 116 1)�/NN 53 Y23 <br /> TYPE OF OCCUPANCY: Residence No.of Bedrooms 2 Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW ✓ ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS -2 S 7 ct PERCOLATION TESTS <br /> SOIL MAP SHEET N `� 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 MIN/IN <br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 <br /> P-i � Y SCC 13c,�N"C 7-c-5i 0A7A / /U 3' 3 3 <br /> P—2- .2,1 f1 I /v0 / 0 - 3 3 G 33 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 /vcNc > 72 y''B//s 4 of C s <br /> B- 2 7 NeV > 7y <br /> B- 3 72 Ncyt > ?Z Y <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and square feet ofujtale areas._ Indicate number of s ware feet of absorption area <br /> needed for building type and occupancy. �T© /��ex A-.t' R i.t1 �'L� Indicate scale <br /> or distances. Give horizontal and vertical reference points. ndicate slope. <br /> o E tr L� 5 <br /> A. i C G BEI 6 <br /> Y Sk. T g[ 4 , U j SL <br /> P414 A [/ A f <br /> T a IF A - d <br /> N <br /> R11 'ok <br /> 94 <br /> u t <br /> T 8L � u <br /> ' <br /> 2 <br /> uS 6C <br /> E � C / N <br /> l ,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) Z7jQy✓ARU k./ 5"('14!'iC3606-e Certification No. _5 yZ� <br /> Address 2 e6�� <br /> Name of installer if known^XrJ.-u <br /> CnPY A—LOCAL AUTHORITY CST Signature <br />