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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:N• Ya,sL/a,Section_/—,TVCN,R�r� (or) W, Township or Municipality � <br /> Lot No. ' ', Block No. ��` 4 TI County /57 4 �,� <br /> Fr <br /> ub IvISIA ame <br /> Owner's/Buyers Name: a V e C /1 <br /> Of <br /> Mailing Address: '` 7 E 7ti f &, PJ A <br /> ✓ r N <br /> TYPE OF OCCUPANCY: ResidenceNo.of Bedrooms COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEWXRECPLLACEMENT. ALTERNATE SYSTEM 0 HER <br /> DATES OBSERVATIONS MADE: SOIL BORINGS 7 / s� � PERCOLATION TESTS �y�� y <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 <br /> RATE <br /> NUM- SINCE HOLE HOLE AFTER INTERVAL <br /> BER RHES THICKNESS IN INCHES 1STWETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> P— Vf Atf <br /> ll 3 <br /> P– <br /> P- <br /> 113– <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 OBSERVED ESTIMATED HIGHEST /�{i IF OBSERVED IN INCHES ) <br /> B— / r r / ,}�r /ice / /'j �� +/ i' S7 �/ L <br /> B— Q �_ .r c, IG r rr <br /> C, <br /> "e)17 T E ,� <br /> B C r C, s( ! S <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plary htenon and square feet of suitable areas. <br /> Indicate number of square feet of absorption area needed for building type and occupancy ' 1— Indicate scale or distances. <br /> Give horizontal and vertical reference points. Indicate slope. P/ �� (U f-f -v d <br /> rI 1 Eft <br /> 4 o r 4rrv~z <br /> (t`�r tic ti ^I a r'1 \ <br /> e � <br /> ",7, fN <br /> - 4- I -� <br /> I I <br /> Ior Olt <br /> Q f l} <br /> - ar <br /> f44 <br /> ---j <br /> -< - -- T 1 <br /> �-- {� J •� � _ 1 i � i <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 /> R <br /> Name (print) F 1 r C /f L �\ I ry S Certification No. / <br /> � <br /> Address <br /> Name of installer if known_ <br /> CST Signature <br /> Copy A— Local Authority N <br />