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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 TEATS <br /> LOCATION: SL)'/4, i• �/4, Section I I ,T dN, R I (or) W,Township or Municipality Cc A—SC /^\ <br /> Lot No. A b , Block No. Ref') Oil tr"'-: Pc) n I (f t `�/cUrcr U I/'4J County Y' f .1 le It— <br /> ,/� / J Al 'nisi n NSme v <br /> Owner's Name: 11 tc Q11 4 r d. t' r.- , l / / <br /> Mailing Address: l S O 3 ei U'P r- C t` e S t �1 f�/•. 4 a ire_ Lq j /1-4 I nn . 45-(d"l <br /> TYPE OF OCCUPANCY: Residence X No.of Bedrooms - Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS 6 --) 7- 7 7 PERCOLATION TESTS 6. / ? 7 7 <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- SINCE HOLE HOLE AFTER INTERVAL <br /> INCHES THICKNESS IN INCHES <br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 <br /> MIN/IN <br /> P- J 3c ----, £J I -4 Po / 0 </ ‘ , `f71. 4q- g- <br /> P- I, t ' / 4 J\JI o / 0 <br /> 4/./73 Li 3 ti ii, (1- - <br /> P-3 —4, ( l( < < I ( Al O / o Y7-69-- 4/1 q <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 gd '' ' o " q /5,7 r 76 'pp () 54nci <br /> B- 3f 0 t o 9.1/15 11 ? 76 "`lyI t 1 O s rt I <br /> B- <br /> Sp PLAN VIEW (Locate percolationtests,soil bore holes a7nd suitable soil areas.) <br /> Indicate on the plan the location and square feet of spi able aes. Indicate number of s&/are feet of absorption area <br /> . needed for building type and occupancy. 44 /. 0 FP" A!' ' e- cG•'' Indicate scale <br /> or distances. Give horizontal and very refer ce points. Indicate slope. <br /> ,f)sp roc <br /> 4c r•c L1 <br /> / s O 0 'i " Svc lQ4w <br /> cSa <br /> fr J s-e, <br /> `sue c 0"Ao, N <br /> i o �b <br /> +a . _ . . <br /> nn oQ j <br /> .c,, <br /> Ilik <br /> • ` 79 7 '/ d AA a o <br /> IA 0_ o.), q, rr" U ,,C / 4 e <br /> -1-d <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.s 7Name (print) •R d I4 T. I'''' l (- 1- �°r I n n 1' Certification No. q 3 <br /> Address W� b 1 t`P~ f1 -1C ' <br /> Name of installer if known is c P J ( t h e <br /> CST Signature <br /> ' ) s�- <br />