Laserfiche WebLink
EH 115 <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> DIVISION OF HEALTH, BUREAU OF ENMRONiMENTAL HEALTH <br /> P.O. BOX 309 <br /> MADISON,WISCONSIN 53701 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> LOCATION: '/4 E'/4,Section V, T_�FN, RYE (or& Township or Municipality On DR ( VER <br /> Lot No. , Block No. _ County S �1 �/ <br /> J� ubdivisi�og Name <br /> Owner's Name: I-J �_4 A/& _ ��ft� <J�<d�/V / / <br /> Mailing Address: / J ( lfl_yrS /� �/i �� cam- <br /> TYPE OF OCCUPANCY: Residence _ _ No. of Bedrooms 3 Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW X ADDI/TION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGSZ-S�/ 7 7 PERCOLATION TESTS 6/Z-S /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- INCHES THICKNESS IN INCHES 1SINCE HOLE HOLE AFTER <br /> INTERVAL <br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> P- 3 D �, C, <br /> SOIL BORING TESTS T,6S u,4/ <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 /> TZ- <br /> B- 7 Z_ 90 t i <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) <br /> Indicate on the plan the locationand square feet of suitable areas. Indicate number of square feet of absorption area <br /> needed for building type and occupancy. !V-� � Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> G % L <br /> Al <br /> kA <br /> !' —EYE, A6zLL_ <br /> OCILL51 <br /> W L <br /> , p <br /> _NkS U <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) �� f� Y / t-— Certification No. S f 2 7 Z <br /> Address 2- CSC, <br /> Name of installer if known <br /> CST Signatur - <br />