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EH 115 Rev.9/78 <br /> r 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:tY., Y<,Section,TJYQN,R,L''4//E-WeTownship.�fRq' • <br /> Lot No. , Block No. —, Subaivision Name —County1 c,,_Aoy�TT <br /> �AkoL <br /> Owner's%Buyers Name: <br /> Mailing Address: 7'A,! /2�/ <br /> TYPE OF OCCUPANCY: Residence a No.of Bedrooms '2 COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT—ALTERNATE <br /> c� ALTERNATE SYSTEM—OTHER— <br /> DATES <br /> YSTEM OTHEERDATES OBSERVATIONS MADE: SOIL BORINGS /0 - 4- - L/ PERCOLATION TESTS lo "s-` 7 / <br /> SOIL MAP SHEET NAME OF SOIL MAP UNIT <br /> PERCOLATION TESTS <br /> W <br /> CHARACTER OF SOIL HOURS WATER IN TESTTIME DROP IN WATER LEVEL,INCHE RArE <br /> THICKNESS IN INCHES SINCEHOLE HOLEAFTE INTERVALMIN/IN <br /> 1STWETTED SWELLING INMINUTES PERIOD1 PERIOD2 PERIOD36Z- v �- .t 0 3 5/ L. <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— '7I g <br /> B— z <br /> B- "T <br /> ir <br /> B— O o <br /> 7W 7z 13 L 7 <br /> B- 7 <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the pl n the location a/rDquare 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. <br /> a <br /> .1 - �L�u/47ioN <br /> _ Hb wSN ♦ <br /> ' A <br /> A _ <br /> /4 R+A GL 1 <br /> /ov,'o rip �t c �<�frvr N <br /> E, Ira 0tiw4 ;,D/I CL <br /> 8_ Sq ` A95L A <br /> p ' <br /> 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 /> Name (print) CL'G/L C2ifdh�F/� Certification No. � Ta� <br /> Address kT, _14'Ve ti/S S'5eV7/ <br /> .Name of installer if known v <br /> Copy A—Local Authority CST Signature <br />