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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.,BQX4Q9 <br /> MADISON,WISCONSIN 53701 <br /> REPORT/ ON SOIL BORINGS AND PERCOLATION TESTS <br /> 5L'LOCATION: -A;si L1/,,Section // ,TON, R` E.-(or)(W/Township osM"niciiaaiiyr Jar, 7— <br /> Lot No. , Block No. County 42,2 ccAd'2 77 <br /> Subdivision Name <br /> Owner's Name: ii LL;A Ai /f/f 6(t.,4 NA/ • <br /> Mailing Address: S 7A►AA 43 Gl./i ics-7:i -' 41'S, <br /> TYPE OF OCCUPANCY: Residence No. of Bedrooms Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS /14.4)' / , /P7r PERCOLATION TESTS .4!f,4r A /97k <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 /> P— <br /> /r ( /1/0 LY ,2./ce 2 <br /> P-3 3O <br /> c rf V� � I ' 1 2' <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— 1 �� 7 �� T$ �'/i XS d: 4 5. 6° <br /> 73 "7, xi' /0, ,T Jr <br /> B- �' 7 ,-7� T� tf /% /e S ��� cr't�'TB .r ib' <br /> rs 51, .[s 7, '5/2, Fs /7 , <br /> B— ..i.- 7;— Ts S, 45 /.3 s' 5q <br /> 7 <br /> Ts S� .0 S j a, S 6-3 <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 areas. Indicate num of square feet of absorption area <br /> needed for building type and occupancy. 0V/0 Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> 6 I° <br /> • r Pt c. / / 4 <br /> 4 - k:zI-4's47.>6/✓ l I <br /> lot c%.z,- / / <br /> S— 4C4,.4.-j / g I I tN <br /> / ‘ <br /> 1 I 1 <br /> i <br /> • <br /> • 3 <br /> p <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) (IC%I- S'e Al.e9A/4-1 Certification No. ,5`5-''5/9? <br /> Address �?,` ,/i/z-44 �/‹4— Cct.S, S#SP,V <br /> Name of installer if known -S''4ii+,' A/41--/r . -1/CA6'ATiik/l <br /> CST Signature afs>1 I ‘.1- C LL'✓ <br /> COPY A—LOCAL AUTHORITY <br />