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EH 115 Rev.9/78 <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: Y<,A�_6Ya,Section ,T_�_QN,R_�fe (or)W,Township orfhtt� C r C <br /> Lot No. , Block No. County F !' r f <br /> Subdivision Name <br /> Tr <br /> Owner's/Buyers Name: Q v F / S _S <br /> Mailing Address: C U 0 - -S d < r' v ' t' toy lZe r (-v <br /> TYPE OF OCCUPANCY: ResidenceNo. of Bedrooms COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW / REPLACEMENT ALTERNATE SYSTEM OTHER <br /> DATES OBSERVATIONS MADE: SOIL BORINGS �� fl PERCOLATION TESTS. ? i3�� o _ <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 /> NI;BVI- SINCE HOLE HOLE AFTE INTERVAL <br /> BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> P- 1 47 V Q iC) 3 0 <br /> P- If <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 E TIMATED HIGHEST IF OBSERVED IN INCHES <br /> B_ �� ti /7 5.;� cV <br /> / _ 7 it <br /> B— .� '1 � - ' 1 rq If <br /> 17 <br /> I' (. <br /> PLAN VIEW (Locate percolation tests,Yoil bore holes and suitable soil areas.) Indicate on the plan he loyli nand square feet of suitable areas. <br /> Indicate number of square feet of absorption area needed for buildi type and occupancy Indicate scale or distances. <br /> Give horizontal and vertical reference points. Indicatestppe.( tt dE <br /> I rc -�S rC w <br /> I <br /> lk� r�t« �,,�, � �,o�`t� /_3 isou T_ <br /> erI, -eet <br /> Irc � O v fC R72rlC � y J -_ -.- . I-- <br /> ail ( fN <br /> !o �'� ) ! <br /> r <br /> 07A ip <br /> —i -} �- <br /> /`i I i <br /> dao <br /> - j- <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 /> j <br /> Name (print) G SLE i` tc 7) Imo} / IN-� Certification No. 7 7 <br /> Address t <br /> Name of installer if known <br /> CST Signature <br /> Copy A— Local Authority ' s — <br />