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EH 115 <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> DIVISION OF HEALTH,BUREAU OF ENVIRONMENTAL HEALTH <br /> - <br /> P.O. BOX 309 <br /> MADISON,WISCONSI N 53701 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS /.- <br /> LOCATION: s'w/4, S /4, Section 02 7,TkeN, R ikE(or) W,Township or Municipality L) <, '�! 44 A i__ <br /> Lot No. , B ock No. �,, County /T t h r 1/ _ <br /> / Subdivi ' Name <br /> Owner's Name: Q r- �C. �-- h �'f'l- �' S 0 r% <br /> W <br /> Mailing Address: r 10S TS r' (....}-1 S C . S— cif 93 <br /> TYPE OF OCCUPANCY: Residence x No.of Bedrooms v Other ^ — <br /> EFFLUENT DISPOSAL SYSTEM: NEW ADDITION h REPLACEMENT <br /> �/ <br /> DATES OBSERVATIONS MADE: SOIL BORINGS 7 — ' - 1 7 19 PERCOLATION TESTS if - J 9 - 7 P <br /> SOIL MAP SHEET SOIL TYPE <br /> PERCOLATION TESTS <br /> TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RATE <br /> NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL <br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> P-1 V° ilQJ4 2(41k M Gt46- )41 tiki 0 0 9t* c: 4 a2if 3 <br /> P—, go it 11 li II i4 jv0 I ° 3-* 3 -1— 3 i 3 <br /> P-3 <br /> ria /I , i Il (ri, kr0 IQ 3 3. 3* 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 /> / 70 /70 `f /37 0' 6 1! Sq/11)i6!r4vioL <br /> e- 3 <br /> is7o 'r > / °7a y ",e,,, Ts / SQi efie G-av'eL <br /> B- / -7° fi i 7 o // 9'"eh ' AI Sanoly /-avr4 <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) <br /> Indicate on the plan the location and square feet of suitable a s.n_dicate pumber 91 squire feet of absorption area <br /> needed for building type and occupancy. I 1 0 7' Are cf Indicate scale <br /> or distances. Give horizontal and vertical reference points. Indicate slope. <br /> i <br /> , r lire it 1 qrq- I S' ,-I; rit*". 1,--, 9- c.A <br /> 4. <br /> 1 <br /> a . . <br /> I <br /> - -I J " it. , <br /> g 0 S e cs,p.,�„„'T- '"° <br /> oo r,,'I , 1 i 1,,‘ fix <br /> 3 <br /> 'r rs /45 <br /> Yb o T -”. _""_ 1-147 le " . <br /> fN <br /> P r or y` p L / d f'v,Jr/S <br /> ` `1 0 c n tr Y` /'7 o vwn @ /SP m <br /> $S- <br /> A <br /> 04j I. <br /> --�yC/S ''if a t!Vy•iL It} 11t;l �Q:�j ,( ,p '!'FIc� kWC..rcn1 �/� t-'gt <br /> r v pLC1Cob►iwent w <4 /4 et)-9 14 0 /Cl/7 <br /> I,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 /> Name (print) Po 4 f'f e IT 4 or .i n ' Certification No. 7 3 7 <br /> Address ( `PLS 7er.- W% SC , S'Cfc9' <br /> Name of installer if known rT '+art kr) <br /> ,f <br /> eC-4":4 1.471<5L. <br /> CST Signature ' <br />