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EH 115 <br /> WISCONSIN DEPARTMENT QF.HEALTH AND SOCIAL SERVICES <br /> DIVISION OF HEALTH,BUREAU Or ENVIRONMENTAL HEALTH <br /> P.O. BOX 309 <br /> MADISON,WISCONSIN 53701 <br /> p) `7REPORT ON SOIL BORINGS AND PERCOLATION TESTS ' <br /> LOCATION: /�WY4,`3�'/4,Section IZ,Tlia1, R/7g6(or) W,Township or Municipality ('' /1 I e <br /> Lot No. , Block No. _ County <br /> 4 r 1 e- Fr <br /> Q Sivision Name <br /> Owner's Name: .1—�O-7.-., �P C iJ 4 r r' 'P ubdC <br /> Mailing Address: �'' 1 6 ('X ' 7 f, 0 r e ! < oPillpi - cC S—7 <br /> TYPE OF OCCUPANCY: Residence /( No. of Bedrooms pt.. Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS / 0 ' 1 7 — 7 Y PERCOLATION TESTS 1 ° 1 ) — 7,,P <br /> SOIL MAP SHEET SOIL 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 <br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> F- ( 'I r!� it /" 0 4, , 1 � <br /> 1 a L ` v /jE� tiJ it <br /> P- 1 i)y il ,r 1 . Av c / 0 s-i s f s <br /> 13-,_? ,9`1 " ' ' t I / ( i t 14 A) ° _.)._ <br /> RI s if7 NT-4- 6-4 1 <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 /> ,. s Ili ii <br /> B- f '7 1 il 6 c Y �4 -ti46 c +�t4- sr S� eld rn^ <br /> B3- 0 `► 67 if f 0 rr ri84 /,I 1' c Curd e Strid 6, eII <br /> B- it it (r (f �� � � (c <br /> 46 Q�7/J (` C Y r �' P Sri ri <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and square feet of suitabl areas. Indicate number of square feet of absorption area <br /> needed for building type and occupancy. y 1 L " u Pr A) cf'F Cf '' Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> ,. - t" I • <br /> ■. ■■ ■ ■ ■ ■ .■ �II�1y • <br /> 1■■■�■� ■ � � ■■ ■� ■�■� <br /> ■FITII_ ..■FEEPIM:■:::==e....■�■ � <br /> IFIVIIMIZIMM:r_MERE.11111111111111011Mell ,I <br /> 1111111111111a00111111111ABO. 1111111111111111111MENII 1E11 <br /> ' gilliiiirMillill111111111116E1311111111111MIEMEINIMMINIM <br /> iiIIIMMIN111111011111111111111111111111i1111111111111111111111111 4, <br /> L ■■■■■ .11 ■■'■■■ �. ■■� <br /> ViIIi11III1UhIIIIIIIl <br /> 311 <br /> 4z ENE 1111.111111111111111_,EDMIIIIIIIIIIIIIT 11111 <br /> 11111 <br /> 7.... VI 111011111=1111111 11111111111111111111111111111111111111111 <br /> ■ RIMINI IIINI111111111111111111111111111111 l <br /> IN ■■ II • ■■ <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 wledge and belief. <br /> Name (print) r r �, Certification No. <br /> Address LJJ E b% /`e'I' W I S� • Li 67? <br /> Name of installer if known <br /> q' <br /> c��E�I�MA�C- �1 <br /> CST Signature L <br /> COPY A—LOCAL AUTHORITY <br />