Laserfiche WebLink
SEPTIC TANK PERMIT NO. <br /> REPORT ON SOIL PIRC0LA ? ION TEST <br /> A N D S O I L B O R I N G S <br /> TO <br /> DIVISION OF HEALTH - PLUMBING SECTI6N <br /> P.O.Box 309, Madison, Wis. 53701 <br /> Pursuant to H 62.20, Wis. Administrative Code <br /> P 8 R C 0 L A T I 0 N T E S T <br /> Test Depth Character of Soil Hours Water Test Time Drop in or Level Inches Minutes <br /> Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall <br /> 13t wetted Overnight in Minutes Last Period Last Period Period One, Inch <br /> Example <br /> P - 0 36" T Soil 10" Clay 261' 25 Yes or No 30 1 2 1 2 1 2 60 <br /> �-- <br /> RECORD DATA FROM MINIMUM OF 3 TEST HOLES <br /> Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. <br /> S O I L B 0 R I N '3 S - Minimum 36" Below Pro osed Abso tion 5 stem <br /> Boring Total Depth Depth to Ground Water Depth to Bedrock <br /> Number Inches Observed Estimated Observedl Estimated Character of Soil with Thickness in Inches <br /> Example <br /> B - 0 72" 7211 Black Top Soil 12lt Clm 18": Sand 1811• Gravel 24" <br /> AIPNr 7"v So�c 31N . !4 c L1571 i�✓ <br /> RECORD DATA FROM MINIMUM OF 3 BORE HOLES <br /> YPE OF OCCUPANCY: / �j ,(� <br /> RESIDENCE: Number of Bedrooms 2-- OTHERs (Speoify) C�: �`A48 I'* Number of Persons <br /> FOOD WASTE GRINDERs Yes No Dishwashers Yes No /` Automatic Clothes washer: Yes No <br /> EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMENT <br /> Tile Size No.Lin.Feet Trench Width Depths Number of Lines <br /> Seepage Bed: Length / Wide T Depth f Tile Size Af 111 No. Lines Y <br /> Seepage Pits Inside Diameter Liquid Depth <br /> I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super- <br /> vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and <br /> that the data recorded and location of test holes are correct to the best <br /> j of my knowledge and belief. �. <br /> NAME -4 'N Cam?� g iite T� ` ' t A R( T/IL/ .S a/j/ TITLE ` ' `A S 7 13 4 l <br /> Type or Print) �N <br /> REGISTRATION pO. or MASTER PLUMBER LICENSE NO. M <br /> ADDRESS 6 n s 90 /'S <br /> DATE ( SIGNATURE <br />