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EH 115 Rev.9/7B -- <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> P.O. BOX 309,MADISON,WISCONSIN 53701 <br /> LOCATION:N LCx' NI%, +� ! �/�, 1-� <br /> Section�/1,L,T�N,R_L.@�lor�Township or Municipality Q • t t (7 Y'l. <br /> Lot No. , Block No. l 3�.'G b2lKesje Loch-'tit"`. County 'tel 4 r h c it <br /> u Ives n Name <br /> Owner's/Buyers Name: �� '� L� I c' <br /> Mailing Address:t ✓1'vl 4 1 J r .� <br /> TYPE OF OCCUPANCY: Residence X No.of Bedrooms -� COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW /� REPLACEMENT ALTERNATE SYSTEM��---- OTHER <br /> DATES OBSERVATIONS MADE: SOIL BORINGS C' PERCOLATION TESTS 277c, <br /> SOIL MAP SHEET NAME OF SOIL MAP UNIT <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 AFTE INTERVAL MIN/IN <br /> BER 1ST W TTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 <br /> P- I -_ < I <br /> P– qb 1t C <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 <br /> OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES <br /> B- 3 7 7< ,, S rrq F <br /> B- Tr <br /> B— -7 (. „ :� It it f 1 <br /> . ;;- a bo <br /> B– 7 . t <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the I tjc�1 dEquare 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, jli•rti` r' d <br /> s <br /> d <br /> 1 ` <br /> A6► I Ion/ lyr <br /> 'whI / C t'?� Sys: t.(EURC� <br /> c�5<© <br /> dpI" 3Sr � <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 belief. <br /> Name (print) Y � _ Certification No.— <br /> Address <br /> o.Address $ ~ 3 <br /> .Name of installer if known <br /> Copy A—Local Authority CST Signature <br />