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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 TESTS <br /> LOCATION*f YoA/a,Sectiorr_Q,T IN, R/--/A(or) W, Township or-Mtw+� Z24 A�J//=1S <br /> Lot No. , Block No. County ����/ y� Z77 <br /> �.• Subdivision <br /> Owner's Name: /� - <br /> Mailing Address: OK Ot ,r(/y�,e/ �c� e6. GtiC� c <br /> TYPE OF OCCUPANCY: Residence ✓` No. of Bedrooms Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW ` ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS d '.0g-e _;�� PERCOLATION TESTS <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 IST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> P] J <br /> tr %r �r j Alb <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— <br /> B- 7 ley. r h tom- ' <br /> / 1 v.� �l'. /, �. V' y ✓`✓,yrs 7i r!' G/ <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and square feet oi ble areas. nate number of square feet of absorption area <br /> needed for building type and occupancy. , Indicate scale <br /> or distances. Give horizontal and vertical reference points. n icate slope. <br /> h <br /> o <br /> iv <br /> e <br /> N <br /> I <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 wledge and belief. / <br /> Name (print e- t 4 Certification No. <br /> I <br /> Address /2•- z- �' <br /> Name of installer if known �� <br /> CST Signature� � /��t <br />