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EH 115 <br /> WISCONSIN DEPARTMENT OF HEALTH 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 /> LOCATION: ��114 LW/<,Section QLd,TYIN, R J(p 1K(or) W,Township or Municipality / Z S <br /> Lot No. , Block o. County ,Y h e <br /> ubdivis n Name <br /> Owner's Name: //V� �r'/ S ! � -C <br /> Mailing Address: LJQ n L4J c' S'C . <br /> TYPE OF OCCUPANCY: Residence �� No.of Bedrooms —Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW q- -I — <br /> / ADDITION REPLACEMENTd� <br /> DATES OBSERVATIONS MADE: SOIL BORINGS y - -I — 7 7 PERCOLATION TESTS z a 77 <br /> SOIL MAP SHEET q g - S S� SOIL TYPE NST Y^a.ow� e d <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 /> P-) ail ' 30 <br /> P-3 I) flt � � ` �� N � 3e �� � <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� " � C_� ` ' `anfi " JL4 <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) 3 ,V /r+, i K p+ cz. <br /> Indicate on the plan the location and square feet of suitable ares Indicate numberdppf sq are feet of absorption area 38 <br /> needed for building type and occupancy. �O C� FT /V r F e Indicate scale off- <br /> or distances. Give horizontal and vertical reference points. Indicate slope. "# a A1C. S S/r rye * jt7 <br /> C • <br /> I <br /> .r1 <br /> 4 <br /> di <br /> .� t N <br /> t <br /> t <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. — 7 <br /> Name (print) • d r 0 10 062 AD Cer ,fication No. <br /> Address uo + � <br /> Name of installer if known -� <br /> CST Signature <br />