Laserfiche WebLink
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 /> TS <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> © 9� 4e <br /> LOCATION: �I'/a,�'/a, Section QP-3, T�N, R 1pY(or) W,Township or Municipality <br /> Lot No. , Block No._—_, —_ County <br /> T 1 l`.I� Subdivision Name <br /> Owner's Name: , 0 S`4 1® 4 4 �P//f iyP-l� �p <br /> Mailing Address: /97- wt 'r Lb S / `t r- L,4t j C 44 d y <br /> TYPE OF OCCUPANCY: Residence X� No. of Bedrooms Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS a `�- '7 '2' PERCOLATION TESTS ` a`� �`7 7 <br /> SOI L 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-1 11 <br /> P� <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 /> ff <br /> X�'y `{ ya 11y /,41/Z , s , c <br /> o " � oyIs <br /> tI <br /> �v C- 04rS�, SCt`td <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and squaree t of sui ble eas. Indicate um r of square feet of absorption area <br /> needed for building type and occupancy. l) 7' /" re I'e Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> 77 <br /> � � I <br /> a x' t N <br /> � 5 i <br /> - _ r <br /> 4 � <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. p <br /> Name (print) t IC ', 4 r Certification No. <br /> Address - Jp <br /> Name of installer if known <br /> CST Signature <br />