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EH115 Rev-9/78 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS V" <br /> WISCONSIN DEPARTMENTDF H€ALTH AND SOCIAL SERVICES <br /> ' p P.O. BOX 309,MADISON,WISCONSIN 53701 <br /> LOCATION:_Y,,_%<,Sectiorb/,eL,T_N,R_E (or)W,Township or Municipality <br /> Lot No. , Block No. _, County <br /> Subdivision Name <br /> Owner's/Buyers Name: <br /> Mailing Address: <br /> TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER <br /> DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS <br /> SOIL MAP SHEET NAME OF SOIL MAP UNIT <br /> PERCOLATION TESTS <br /> TEST DEPTH HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES <br /> NUM- CHARACTER INCHES <br /> SINCE HOLE HOLE AFTE INTERVAL RATE <br /> BER INCHES THICKNESS IN INCHES MIN/IN <br /> 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 <br /> P— <br /> P— <br /> P— <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 /> NUMBER INCHESTEXTURE,MOTTLING AND DEPTH TO BEDROCK <br /> OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES <br /> B— <br /> B— <br /> B— <br /> B— <br /> IB— <br /> B— <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square 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 /> IN1,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 belief. <br /> Name (print) Certification No. <br /> Address <br /> .Name of installer if known <br /> Copy C—Property Owner CST Signature <br />