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EH 115 <br /> WISCONSIN DEPARTMENT-Or- KEALTH 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 TESTS <br /> � <br /> LOCATION: ^'�rj-/4,is/4, Section 4m, TMN, R A LA(or) W, Township or Municipality /_' � e h <br /> Lot No. , Block No. �-- .County <br /> tiJ 6 � n S o ti Subdivision Name <br /> Owner's Name: O p <br /> Mailing Address: a E a "d ' '" t r rk •Z ! ri ' <br /> TYPE OF OCCUPANCY: Residence No. of Bedrooms � —Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW_ X \( ADDITION---REPLACEMENT--. <br /> DATES OBSERVATIONS MADE: SOIL BORINGS 'p — �- c — 7 PERCOLATION TESTS �T 9 a 7J <br /> SOI L 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 /> 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 /> NO <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 7) if s- 1 <br /> 116,t T rc 7 ` ` o cl <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 ar In I ten tuber�(�f squre fFet of absorption area <br /> needed for building type and occupancy. _ �© �" �' Q Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> AR <br /> led <br /> o` r <br /> _ I <br /> i <br /> i <br /> �I <br /> , • <br /> I I <br /> 3c , <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 /> �` v1 i'C rU i S j <br /> Name (print) Certification No. <br /> Address <br /> Name of installer if known o ja rS <br /> CST Signature <br /> COPY A--LOCAL ALITHORITY <br />