Laserfiche WebLink
EH 115 <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> DIVISION OF HEALTH,BUR.EAU'OP ENVIRONMENTAL HEALTH <br /> P.O. BOX 309 <br /> MADISON,WISCONSIN 53701 <br /> �/'� .REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> LOCATION: (ILC'/., 5Z''I.Section 1 12�,TYON, R SFJ lar)W.Township or Municipality— Cf C' aO <br /> Lot No. , Block No: County <br /> / ✓ rr <br /> /) ubdiwsion Name <br /> Owner's Name: _!J r NGC //:� .-a'4 n3 o r`L <br /> Mailing Address: �I 13 �r r a - �� J. O �r)>S' lh'1 i'1 n <br /> TYPE OF OCCUPANCY: Residence'_ No.of Bedrooms _ Other - <br /> EFFLUENT DISPOSAL SYSTEM: NEW - h ADDITION REPLACEMENT <br /> i <br /> DATES OBSERVATIONS MADE: SOIL BORINGS f— 7J PERCOLATION TESTS <br /> SOILMAPSHEET n SOIL TYPE <br /> PERCOLATION TESTS <br /> TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROPINWATERLEVE LINCHES RATE <br /> NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MINhN <br /> BER 1STWETTED SWELLING INMINUTES PERIOD I PERIOD 2 PERIOD 3 <br /> iib Citi � <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 7a " � 7a , �>,, t 61'"tel d se d/ o <br /> > H <br /> U / <br /> PLAN VIEW (Locatewenlationtests,soil bore l areas.) <br /> Indicate on the plan the location andsquare feet of n le eas dicesfe�nytuber offs ruare feet of absor tion area <br /> - needed for building type and occupancy. /"�"P�P" 'Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. _ <br /> pG o <br /> LrNc <br /> EL <br /> e - - rest. , o <br /> tNI <br /> n <br /> ' <br /> 1 is ! <br /> f , , 1! <br /> QI t IM <br /> ( Lt O <br /> t.J 1(i <br /> _ 1 <br /> 1 <br /> 1,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 /> Lo C/"r rr c d Q' �i � r <br /> Name (print) T� Certification No. <br /> Name of installer if known �^^"E •� - _ <br /> - - CST Signature <br /> COPY A—LOCAL AUTHORITY - _ - <br />