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EH 115 Rev.9/78 <br /> REPORT ON SOIL BOVtINGS AND PERCOLATION TESTS <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> ' II r� P.O. BOX 309,MADISON,WISCONSIN 53701 <br /> LOCATIO/N�:L✓tA�Y<,Section�,T°4N,'� (or)W,Township orfNndtelpeFity S`�/�S <br /> Lot No.1� .—, Block No. l� 0.4.C• G41L ameO,✓, • County 16—C c_W10 <br /> ivlsion <br /> Owner's/Buyers N 3 <br /> Name: D hN IC T �"?r r',Lf• qq <br /> Mailing Address:/�8 �' .2AV� !7'I P,;✓NEA v _T M ✓j yd O <br /> TYPE OF OCCUPANCY: Residence No.of Bedrooms I— COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW_ REPLACEMENT ALTERNATE SYSTEM OTHER <br /> DATES OBSERVATIONS MADE: SOIL BORINGS 1 a PERCOLATION TESTS <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 HOLEAFTE INTERVAL MIN/IN <br /> BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 21 PERIOD3 <br /> P- 4 '�- <br /> P L L. 4 <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 OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES <br /> B- 1 7-. 410 4.05 7__ <br /> B— 7 1 n > z 3 L e, y <br /> 6r, m <br /> B— S Z aars J7:Z. AeS 6d <br /> e— <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the I n the loc t on 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. <br /> ive, <br /> TN <br /> b /3/�? s1/ea , ae <br /> PO e-16 <br /> 6,1 66 <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 /> be1rQ� <br /> Name Ip -S7sJ/ --Certification No. <br /> Addres <br /> 'L <br /> .Name of installer if known <br /> Copy A—Local Authority CST Signature <br />