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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: '/4, /4,Section L ,Ty—A, R/A(or) W,Township or M6a=palit* 114 - S O N/ <br /> Lot No. , BlocLLkLL No.—, County LZ�i✓�� <br /> Subdivision Name <br /> Owner's Name: 4411, <br /> Mailing Address >17(� eclL'3 <br /> TYPE OF OCCUPANCY: Residence —x__— No.of Bedrooms Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW /` —ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS 4q— /— 7 a PERCOLATION TESTS` ��i 7 <br /> 5 . <br /> SOIL MAP SHEET SOI L TYPE <br /> PERCOLATION TESTS <br /> TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL,INCHES RATE <br /> NUM- INCHES THICKNESS IN INCHES SINCE HOLE HO LE AFTER INTERVAL <br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> P_ <br /> Q �� c� ti <br /> PSS Lr <br /> a ,� 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 /> l S 10,,1z2' <br /> "/c L' C� S4,-Jo <br /> e— <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area <br /> needed for building type and occupancy. Indicate scale <br /> or distances. Give horizontal and vertical reference p nts. Indicate slope S <br /> fP 6" 10 <br /> L <br /> I ! <br /> S <br /> <IA. <br /> N <br /> 044 11 1 { <br /> I <br /> -CI <br /> I < <br /> p <br /> I 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 M knowledge and belief. <br /> / <br /> Name (print)f/S V /e/�,LYFi Certification No. <br /> Addressrg �ctryytJisc� <br /> Name of installer if known B/f/�� <br /> CST Signature /- + : /®O/"' <br /> �., ., .. ,. <br />