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EH 115 <br /> WISCONSIN DEPARTMENT OFF' ALTH AND SOCIAL SERVICES <br /> DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH �•� <br /> P.O. BOX 309 <br /> MADISON,WISCONSIN 53701 <br /> /G_ .��/��//�J� `�rREPOpi ON SOIL BORINGS AND PERCOLATION TESTS //� <br /> LOCATION: NL1/4 ►'C'/4, Sectio26, T�/N, R/J E (or&Township or Municipality ST //i LltiY 4 Z <br /> Lot No. , Block No. , 4//2— OF i4 c1./ T 0 County (k / E T� <br /> __SubdivisionDo . Name \� <br /> Owner's Name: --T /�/, y l S_ /4/ m 1 / <br /> Mailing Address: F �^� -3 G RA NT� E u /-" _6- ) �'v / <br /> TYPE OF OCCUPANCY: Residence 2C No. of Bedrooms 2 Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW x / ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOI 1L BORINGS D/_ PERCOLATION TESTS /n/2 k <br /> SOIL MAP SHEET (hO C V/-�C L1';�JLeSOILTYPE <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 / IV e_.e Poe ms �//kr�F C� ' ` % y /Z 17 / <br /> 7-8 <br /> P-� a `f // t/ // S c / <br /> SOIL BORING TESTS 7 E A N 1 Tes I <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 /> 8 / 7 7 Z G F /S S L. Tani A $'Ntie.a S 7'/ / ifl6 T S <br /> 2_ C S No A/c 6 .Z - / `/ S �t�[s C 2 MP Q S (� A iY\OT S <br /> B 3 (.: C. U 0 /LY s g(3/ Ts 6 U Ake_0 S <br /> E/ 7 Z 66 G /S sz_ iKu 7-s 641Mcn s ‘ i°/1-1v7-S <br /> B s 6, F 6 2 6 0 • /s si--1Wv Ts 6O4'Le-A 6S , _ Ale)i S <br /> C 7 C 6 /s t_4iyT 5 Me hac 7 z R irin-i <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) MC�TT�-es 4,_c. Fr,w FAINT <br /> Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area <br /> needed for building type and occupancy. _1f 7 O Sg_ Fr" Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> cr_AL j / // '1o' <br /> ALre.,,a 1the- S ter. A--ea_ ____________ , <br /> 4''° Ar�e,4 b ARkows bvili ram. ia e_ <br /> I •-•"‘ ""E 2..:111C f;. I <br /> i 'l• 4, , <br /> .r N <br /> f <br /> Ci # <br /> • <br /> K <br /> r <br /> T&A!LOii, tuns e ‘, <br /> L® is I/6©/ F OAA, o . <br /> , 4- <br /> .. I - 1V61WAy <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 � J and belief. c � / � �� <br /> Name (print). C,-/R Y Certification No. <br /> Address K. a Z 6 RA 7s 6 \'/ \ ` <br /> f) <br /> Name of installer if known 1'1 AR/1(18 ivkQ S ) VY e k'Scl e <br /> CST Signature Q <br /> COPY A— LOCAL AUTHORITY <br />