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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 /> AU, <br /> ON SOIL BORINGS AND PERCOLATION TESTS <br /> LOCATION: 0'/., Y����um�'rG,Section A.,TYM, R L75 (or)W,Township or Municipality <br /> Lot No. . Block No. County `J `' <br /> /� ubd�Wsion Names- - <br /> Owner's Name: �> /J/V •+ �' 1 '/` .n / S f.rc, <br /> Mailing Address: <br /> lJ' / QA SI1VP OV( SC Y1 <br /> TYPE OF OCCUPANCY: Residence No.of Bedrooms Other r <br /> EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOILBORINGS-7 - /Z' _ 7 - PERCOLAT19N TESTS �" 12 <br /> SOIL MAP SHEET '1 _ y 0 SOIL TYPEP0�/^'' ^z <br /> PERCOLATION TESTS <br /> TEST DEPTH CHARACTER OF SOIL HOURS WATERIN TEST TIME DROP IN WATER LEVEL,INCHES RATE <br /> NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLEAFTER INTERVAL MIN/IN ' <br /> BER 1ST WETTED SWELLING IN MINUTES PERIODfIPERIOD Z PERIOD 3P- i- i <br /> 1t rL fl ' V_ •11oV lrb �y /L c� ! <br /> / SOIL BORING TESTS <br /> TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOI L WITH THICKNESS. INCHES <br /> NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) - <br /> + (fir/ S6 11 3o " , r- I et, . SRI r1 ( ur rl <br /> I, <br /> I <br /> B- 3 t= 4 <br /> B C p // 7 ? 6 gn 60 <br /> I rS, C' <br /> PLAN VIEW (Locate percolation testssoil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and square feet of suitablg eas. Ir�q to nu aer of sgGare cleat of absorption area 1 <br /> needed for building type and occupancy. I rT t A d Indicate scale <br /> or distances. Give horizontal and verticalreferencepoints. Indicate slope. L 0 <br /> f v :• 1 y W r rt <br /> 1 <br /> r .P ,7 _ <br /> e s N � <br /> N\ t s Ov ` •� <br /> _ __ 9 a- <br /> -1'7 <br /> I r9 <br /> s. ; Q 4 , 4 ��: .E <br /> yc' l 40 <br /> I <br /> I E <br /> n , b, c <br /> � t_� , <br /> I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures l <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. - 1 <br /> L 7 <br /> Name (print) P Certification No. � � - f <br /> _ Address i, t+.t r SL <br /> Name ofinstaller'fkno I tNry-✓�+ -I <br /> D J `' <br /> can _ CST Signature-� ,p-GLM.t.L�2. <br /> COPY A—LOCAL AUTHORITY - - � • - <br />