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EH r115 <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> DIVISION OF HEALTH.BUREAU eF ENVIRONMENTAL HEALTH <br /> P.O.BOX 309 <br /> MADISON,WISCONSIN 53701 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> w • LwI <br /> LOCATION: �/., u�"'I'/.,Section_�,T��d, R �'f (or)W,Township or Municipalityr-{- <br /> Lot No. , Block No._, -z- - County <br /> �� Qr VI A) P / fiubdivision Name - <br /> _ Owner's Name: `e r rSn r. <br /> Mailing Address: � 706o y1/ ' FF nLprc .(2 <br /> TYPE OF OCCUPANCY: Residence �`— NNo.of.Bedrooms 1 Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS-7 - � <br /> V PERCOLATION TESTS -7 �•- o - 7 7 <br /> SOI L MAP SH E ET SOI L TYPE <br /> PERCOLATION TESTS - <br /> TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL,NICHE RATE <br /> IN INCHES THICKNESSCHARACTER OF SOIL IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN <br /> BER 1STWETTED SWELLING INMINUTES PERIOD 1 PERIOD 2 PERIOD 3 <br /> /r <br /> Pz . 41 y <br /> P_ <br /> 2 <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 %a u <br /> o <br /> PLANVIEW (Locate percolationtests,soil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and square feet ofsppitable reap Indi to number of, Iua feet of absorption area l <br /> needed for building type and occupancy. d. O 7` /" �° " Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> 4 70'6 I <br /> " I4 IN <br /> �I I <br /> <I <br /> o <br /> 4 <br /> S P' <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 /> Y � <br /> Name(Pring RC � V� sc 1 I I� N �! r7 S Certification No. <br /> Address L'J e' <br /> Name of installer if known <br /> CST Signature <br /> COPY A—LOCAL AUTHORITY - v I <br />