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EH115Rev-9/78 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> ' p P.O. BOX 3)'09,MADISON,WISCONSIN 53701 <br /> 1 Y. <br /> LOCATION:.S ,E'/.,Section_a,T#QN,R1p! (or)W,Township or Municipality <br /> Lot No. , Block No. County7 <br /> Q u I on me <br /> Owner's/Buyers Name: �-t-9j�/ n <br /> Mailing Address: E Y/ ►1 ex C D 'd 0 <br /> TYPE OF OCCUPANCY: Residence No.of BedroomsCOMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW_ REPLA EME T ALTERNATE SYSTEM OTHER <br /> DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS A <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,INCHESRATE <br /> NUM- SINCE HOLE HOLE AFTEF INTERVAL <br /> BERINCHES THICKNESS IN INCHES 1ST WE TED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN <br /> P- 1 36" l d C 3 .� <br /> t U T 3 <br /> P-3 6" 0 3- <br /> P_ <br /> P_ <br /> IP— <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- 1 7� " 7a 5 ,r ca � s� SE <br /> B- k7 -7 D rr� <br /> B- a 0n 7 ' <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the pia th he and square 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. tel/ `F -e '' <br /> X�Or 'f' CI <br /> 1 <br /> T- <br /> 10 <br /> TOL <br /> � <br /> eC,- <br /> q0, <br /> ID� <br /> • Ip d� j- 6 le <br /> c- S' 1� b a v <br /> 0t w/ rrf f <br /> car S S <br /> S yc- ���� <br /> h�aaS` <br /> X"E 1 o W G. 4 <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 /> I I 4 <br /> Name (print) ul 6 a C r Ic 4 Oo„ ' 1 f VI S Certification No. 7 <br /> Address s r ( _Sc' <br /> S 3 <br /> Name of installer if known <br /> Copy A—Local Authority CST Signature <br /> _ O <br />