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EH 115 Rev 9/T8 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> P.O.BOX 309,MADISON,WISCONSIN 53707 <br /> LOCATIONr��%., %,,Section ;f ,T-4ZLN,R!fi(or)W,Townsh'porAb=upway ro 11 ZZ Sc <br /> Lot No._L�_,Block No. L c-. County n F <br /> u ivislon ame <br /> Owner's/Buyers Name: L �n;gF// r I c Q L� <br /> Mailing Address:. 1 ? y y 7r G fh ti r -f f � u'� ry r'7 ' II G 01444 r C 3C � <br /> TYPE OF OCCUPANCY: Residence No.of Bedrooms COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM. NEW�_REPLACEMENT ALTERNATE SYSTEM OTHER <br /> DATES OBSERVATIONS MADE: SOILBORINGS �I �I�:_._,L� PERCOLATION TESTS_//�!/b��J??� <br /> SOIL MAP SHEET /// NAME OF SOIL MAP UNIT <br /> PERCOLATION TESTS <br /> TESTDEPTH CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL,INCHES <br /> RATE <br /> NUM INCHESTHICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN <br /> BER IST WETTED SWELLING IN MINUTES PERIOD PERIOD( PERIODS <br /> P- c e 3 <br /> is ' 423 <br /> 3 „ GC 3 � 3 3 <br /> P- <br /> P- <br /> P- <br /> SOIL BORING TESTS <br /> TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, <br /> TEXTURE,MOTTLING AND DEPTH TO BEDROCK <br /> NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES <br /> / <br /> B_ I Y t 1 r�.p - _ r 7 '1 <br /> B- � -> ' I I. 7 r r I I <br /> B_ ,lat •I ' (1 f, <br /> I <br /> B <br /> PLAN VIEW(Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plasquare feet of suitable areas. <br /> Indicate number of square feet of absorption area needed for building type and occupancy ,Indicate scale or distances. <br /> Give horizontal and vertical reference points.Indicate slope. <br /> S4c�+ 7 t ^car c E <br /> I� it b r t Q <br /> 44 <br /> f� Sur F <br /> ¢ tett <br /> j �N <br /> 1 �a If I <br /> �E <a r <br /> FI N'e ..Tc h r,l <br /> oMOr-h lot <br /> U c (7 r .— <br /> +�I 4 Q E <br /> I,the undersigend,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods <br /> specified in the Wisconsin Administrative Code,and that the data recorded and location of test holes are correct to the best of my <br /> knowledge and,b�seellliief. <br /> Name(print)_.iLj.._ V, 'T�I if � Certification No. -y 7 <br /> Address L <br /> 1 <br /> Name of installer it known___—_ -4 <br /> Copy A—Local Authority CSI Signature_. 14 Vim- w�-i <br />