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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 308 <br /> MADISON,WISCONSIN 53701 <br /> REPORT ON 1S�O-IL BORINGS AND PERCOLATION TEST <br /> LOCATION: a:r '/., .'/.,Section 15_T%N, R,/TP(or)W,Township or Municipality y 4 C 'r c I,- <br /> LOCATION: <br /> No. —Q • . Block No Grrp '� "/ <Q(' County <br /> bfi rq Name <br /> Owner's Name:_�pr` Su <br /> Mailing Address: UrOt vz'/��j .YHs • rl �yT .' Cit '7 <br /> TYPE OF OCCUPANCY: Residence —qNo.of Bedrooms Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW J, / ADDITION-REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOILBORINGS 7 7 LE_/7�PERCOLATION TESTS <br /> SOIL MAP SHEET SOI L TYPE <br /> PERCOLATION TESTS <br /> TEST DEPR1 CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER,LEVEL,INCHES RATE <br /> NUM- IBES THICKNESSIN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN <br /> BER 1STWETTED SWELLING IN MINUTES PERIOD 1 PERIOD 7 PERIOD 3 <br /> P- Ir I <br /> Pct „ �. e c 3 ' 3 <br /> i <br /> SOIL BORING TESTS - <br /> TEST TOTALDEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOILWITH THICKNESS, INCHES <br /> NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) <br /> I <br /> B ' 7 7rl ;� a <br /> B JL. II 7 7r)- ,r 6 /7.a,27 <br /> PLAN VI EW (Locate percolation tests,soil bore holes and suitable soil areas.) ! <br /> Indicate on the plan the location and square feet of suitable areas. In&ate,nu ber of j'gUr feet of absorption area <br /> needed for building type and occupancy. �.� �••<= df d Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. - <br /> c 1e b <br /> " F <br /> (t r T- <br /> I <br /> •r. <br /> O i <br /> t N <br /> K IC-- <br /> 1, <br /> CI,the undersigned,hereby certify that the soil tests reported on this form were a by me in accord With the procedures i <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 It_nowladge and belief.r`[� r <br /> Name (print) �k n c'r e r C i-V f% ({4 �1 t"2 S' Certification No. / 3 <br /> Name of installer if known <br /> CST Signature ' l' <br /> COPY A-LOCAL AUTHORITY I <br />