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Eli 115 Rev.9178 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> ,((fi�r/� P.O. BOX 309,MADISON,WISCONSIN 53701 <br /> LOCATION:��'/<�t %,Section /t/�,T L0 N,RZAL /— <br /> D(or)WW,Township or Municipality �/ /) S t 04�1 <br /> Lot No. rj`� Block No. � '+- 1� / r C County L 1\ ki 9- <br /> Owner's/Buyers <br /> Owner's/Buyers Name: L L r �� krIg <br /> Mailing Address: PC //I n <br /> TYPE OF OCCUPANCY: Residence No.of Bedrooms COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER <br /> DATES OBSERVATIONS MADE: SOIL BORINGS CI PERCOLATION TESTS—2/Z C' <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 /> 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 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 <br /> OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES <br /> B- 7 a " 2, �'76L. o c <br /> iL I/ Irlei 71 <br /> B <br /> B- s' ? y /6-1 <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on thep Ian the loc§ on a d square feet of suitable areas. <br /> Indicate number of square feet of absorption area needed for building type and occupancy ^ �I .Indicate scale or distances. <br /> Give horizontal and vertical reference points. Indicate slope. /lu <br /> rc <br /> tl <br /> riS. ,,e <br /> aZ 0 FT <br /> few hffH, 04 6�0g,C fiLgar� C 0 <br /> a� ' tN <br /> •tea ll!:� 3o ' <br /> } h 4 ��r <br /> 4C 1 <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 /> ` , <br /> Name (print) 0 1 V 1 Certification No. <br /> Address W f S 9 <br /> Name of installer if known <br /> Copy A—Local Authority CST Signature <br />