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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 /> 1 ' QREPORT ON SOI L BORINGS AND PERCOLATION TESTS+ <br /> LOCATION:sw'L,P-M.,Section _(—° ,T_'LIN, R LTE(or)W,Township or Municipality <br /> Lot No. , Block No. - County <br /> Subdivision Name - _ <br /> Owner's Name: C1--•1/_/ t!. ."-,P r- " <br /> Mailing Address::: 4- _ - <br /> TYPE OF OCCUPANCY: Residence _x NNo.of B <br /> o. edrooms Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW �` ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOIL BORINGS 'S' a 1- � PERCOLATION TESTS <br /> SOIL MAP SHEET SOI L TYPE <br /> PERCOLATION TESTS <br /> TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEBT TIME DROP IN WATER LEVEL,INCHES RATE <br /> SINCE HOLE HOLE AFTER <br /> NUM- INCHES THICKNESS IN INCHES INTERVAL MIN/IN <br /> BER ISTWETTED SWELLING INMINUTES PERIOD t PERIOD 2 PERIOD 3 <br /> if 1t / /U D l O <br /> P3LIa l No to S y 3 <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- �O <br /> 3 "�Q T <br /> B-3 Fo tr r1 3 ,7 '17 n Cov� S.e <br /> e 8o I I 7 J pd f 1 ",64 75 77t 11 c o Y r s <br /> PLANVIEW (Locate percolationterts,soil bore holes and suitablesoil areas.) _ <br /> Indicate on the plan the location and square feet of sui ble rea Indicate qqu/�i of s L}�re feet of absorption area <br /> needed for building type.and occupancy. D FTN'F h deQd Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> - It <br /> I <br /> IL <br /> 11 In <br /> tc --. 4r <br /> I,the undersigned, hereby certify that the soil tests reported on this farm were made by me in accord with the procedures <br /> - <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/k(np�wI cl a and belief. <br /> Name (print) --14- �-----TTl---��I ��— ` L1 /1 1 A d Certification No. � <br /> Address L-0 1 Sb kr <br /> Name of installer if known <br /> CST Signature <br /> COPK,A—LOCAL AUTHORITY <br />