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EH 115 (11-74) <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: —'/., `_k,Section _, T_N, R E (ad W,Township or Municipality - <br /> Lot No. , Block No. County / <br /> £ ubdivision Name <br /> Owner's Name: • <br /> Mailing Address: <br /> TYPE OF OCCUPANCY: Residence No.of Bedrooms Other <br /> EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT <br /> DATES OBSERVATIONS MADE: SOILBORINGS • '" PERCOLATION TESTS = - <br /> SOILMAPSHEET 'A '�' / SOIL 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 MINIIN <br /> 1ST WETTED SWELLING IN MINUTES PERIOD I PERIOD 2 PERIOD <br /> BER 3 <br /> P_. <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 <br /> I f <br /> PLAN VIEW (Locate Percolationtests,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. -y l 't o - Indicate scale <br /> or distances. Give reference point. Indicate slope.' r . 1=/ <br /> t <br /> - I I ), <br /> N is � i R • , �, �� <br /> } A ` -N � <br /> fir , t. . . n i • �� � , t R <br /> I,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord with he procedure, <br /> and methods specified in the Wisconsin Administrative Code,and that the data recorded and location of test holes are otrrrect <br /> to the best of my knowledge and belief. <br /> Name )Print) 'J s l• 'a-< � I •t T�ia�. \��`s <br /> R•'0 '�. T.F _ <br /> Certification No. ' 1=- -f Signature <br /> Name of installer if known I <br /> Copy C - Local Authority <br /> t V <br />