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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 3e9 <br /> MADISON,WISCONSIN 53701 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> LOCATION: S.CE'/a,/ 1/a, Section 19, T UN, R lii@ (or) W, Township or Municipality elki / 0 <br /> Lot No. , Block No. County te'-. ,1 e 7 <br /> j-Subdivision Name <br /> Owner's Name: ,� A r A-1 ff f` I-, n S � <br /> Mailing Address: 3 7 d , Ty <Z'i- S i N. K^ - /hi\p4'S 4). irry ++ ;r J-4-Id <br /> TYPE OF OCCUPANCY: Residence X No. of Bedrooms o� Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW X. / ADDITION REPLACEMENT <br /> r/ r DATES OBSERVATIONS MADE: SOIL BORINGS S� , 7 PERCOLATION TESTS 'V 'S' 7 <br /> SOIL MAP SHEET SOIL TYPE <br /> PERCOLATION TESTS <br /> TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES' RATE <br /> CHARACTER OF SOIL <br /> SINCE HOLE HOLE AFTER INTERVAL <br /> NUM- <br /> INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 BER MIN/IN <br /> P-3 j--- " , , , , , , i <br /> i y k f 0 a '...-,_ ct -6- r <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- f 7 "` (( rr �/ <br /> l I <br /> o� 'S� /3)7 �� 6 '!7 !)Y1 n� S'Ci 4. <br /> B- / i/ % -2 ')` LI rr /Q4, LT 6 v7 rI "1 e 4 SC< 4 iT <br /> d- <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and square feet of suit I reams to umber ofjsquaye feet of absorption area <br /> needed for building type and occupancy. � / f r %I- c6 Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> , <br /> 19 1 ,gprG a <br /> '7 d fe4,— <br /> aIV <br /> �C rd <br /> S yo <br /> i • � r <br /> - 100 pf <br /> r� <br /> .7.i. <br /> t f..r t / Stiijibl,'k _ <br /> to CI <br /> L I c ' er r �• <br /> ? ! C <br /> iPI-oto Fr \y i S <br /> ! ! ( , ' 1 �._ N <br /> 6 Qec, 4 4 3 A- <br /> -f- vv. <br /> t pi.,:, vit 1 <br /> c:4o pr ly SAC C <br /> VCtT4 L..v i= /ck <br /> • I ! I L" G 4___________-___�__�__ _____ c,� !N_ _ __�_ _. <br /> i . , 1 .\ i <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 /> / <br /> Name (print) /O @ 4, r lC � H la To fr 'i S Certification No. C/ ._ l <br /> Address .1: 1' In 1 r'G rs k-k.%1.l C. . v 5f 19 3 <br /> Name of installer if known 6 p If i it CC41;CST Signature . .0 4e i <br /> J 1 <br /> COPY A— LOCAL AUTHOR <br /> ITY = v'; <br />