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EH 115 <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> DIVISION OF HEALTH,B{UREAU OF ENVIRONMENTAL HEALTH <br /> Y.O. BOX 309 . <br /> MADISON,WISCONSIN 53701 <br /> F h.r <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> LOCATION: Iv`"^/<, N., Section s�,T3& R AX(or) W,Township or Municipality /p"I --c r m 0 h <br /> Lot No. , Blo k No. County 11 P,t <br /> Subdivision Name <br /> Owner's Name: I S 0 <br /> Mailing Address: 0 3 E .S 1 h T Y,. W ( �3� <br /> TYPE OF OCCUPAN Y: Residence No.of Bedrooms C Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW _ADDITION REPLACEMENT <br /> DATES OBSERVATI DNS MADE: SOIL BORINGS If -,;L/— — 7 'r PERCOLATION TESTS <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 HOLE AFTER INTERVAL <br /> BER IST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> 3;F 37F <br /> P '3 3(O '' l N' 0 / � 3 L 3" 31 3 <br /> SOIL BORING TESTS <br /> TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES <br /> NUMBER INCH S OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) <br /> / <br /> lj/ 7rL39�3 / 4 � /'1'!1 @ d/ 'S 4 h d/ Q <br /> B_3 <br /> 8d I 7I0 rr V ";S* rJ� 016 n„ ed fS F' h c/ 4 <br /> B- 9O I( I :PC (' /! 4 V 71 �� VCen l/) <br /> PLAN IEW (Locate percolation tests,soil bore holes and suitable soil areas.) <br /> Indicat on the plan the locationand square feet of suitable ar¢ y Indite numbgr of sgyere flet of absorption area <br /> needed for building type and occupancy. 7 G © Fry Tr die �( Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> r • <br /> 4' Q 6 4 -T <br /> - -- - <br /> if <br /> or <br /> I <br /> � I <br /> I r <br /> I _ <br /> r101 nl d d <br /> 4- <br /> - $ + <br /> y I <br /> t , I <br /> I,the undersigned, hereby c rtify that the soil tests r�--i d on this form were made by me in accord with the procedures <br /> and methods specified in the Wisconsin Administrati e,and that the data recorded and location of test holes are correct <br /> to the best of my knowledge and belief. � / <br /> Name (print) 0J't t Irc � It ISR /d IN S `7 Certification No. i 7 <br /> Address— 'TL 37, r Wf-gC , yQF <br /> Name of installeh if known <br /> CST Signature <br /> COPY A— LOCAL AUTHORITY <br />