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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: fig %, '/a,Section ,T_N,R_E (or)W, Township or Municipality r,•. t ill rc` =;A 1 4"'
<br /> Lot No. , Block No. County
<br /> Subdivision Name
<br /> Owner's/Buyers Name: • Lb- `i I
<br /> Mailing Address:
<br /> TYPE OF OCCUPANCY: Residence ice. No.of Bedrooms COMMERCIAL
<br /> EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM ` OTHER
<br /> DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS /! 2 F.470
<br /> SOIL MAP SHEET NAME OF SOIL MAP UNIT t '
<br /> (F •-i, )
<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 AFTER INTERVAL MIN/IN
<br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
<br /> P- 1 iv' •r.- - ,2. ' KFa/ . 3 ^r%) £-y- "=, 4.-'
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<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
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<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 4 I C r T 4 ,Indicate scale or distances.
<br /> Give horizontal and vertical reference points. Indicate slope.
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<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) I - I\, _ u Certification No. ��'
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<br /> Address k f ; 1-S k{,.. 4,j .i Ii 'S f 2 7 C%
<br /> Name of installer if known r /',I f-: .ft L,
<br /> Copy A— LocaI A th ri ty CST Signature >j.�,%r:�1,,,')/
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