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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 /> C r� P.O. BOX 3309,MADISON,WISCONSIN 53701 / `'n <br /> LOCATION: S ' 5 k/,,Section /3,T�N,RLSLr-1 W,Township or Municipality hp /V.L.J��•- <br /> Lot No. , Block No. _' <br /> Coun <br /> dRTIt b v - ame <br /> Owner's/Buyers Name: w <br /> Mailing Address: STFx Wi5o <br /> TYPE OF OCCUPANCY: Residence—x . No.of Bedrooms Z COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW xREPLAC MENT ALTERNATE SYSTEM—OTHER— <br /> DATES <br /> YSTEM OTHERDATES OBSERVATIONS MADE: SOIL BORINGS 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, INCHES RATE <br /> NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/INBER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 <br /> P— go 6 " $ <br /> P- e r caRese r / / 07- 1 ZP- � <br /> SOIL BORING TESTS <br /> TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, <br /> NUMBER INCHESTEXTURE,MOTTLING AND DEPTTHH TO BE OM �OCK <br /> OBSERVED ESTIMATED <br /> HIGHEST IF OBSERVED IN INCHES <br /> B— �/© " SAY' COARSEAr7 'cogsrsAwp <br /> B- a !/ z�!" s " dRC,o RSEs M <br /> B— <br /> B- / " E zV"OFd S'r�7l3R Rslr wC <br /> B— ? N // "IXORM7£ s 'ZV"O&RC -or'LTBrtC' MAW <br /> B- 1 1l "Me ME 5 z '' At 4r139c sr <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan he loc yon and square feet of suitable areas. <br /> Indicate number of square feet of absorption area needed for building type and occupancy 1;Z17 .Indicate scale or distances. <br /> Give horizontal and vertical reference points. Indicate slope. pt{/y1.r0 /QG�KI RCS• <br /> P�aPE -7s-0 (�E1UeNMfMK lfoLOCE <br /> 01V ATS N NE ' E4 100.00 <br /> I 13oTTOA OF <br /> 131 SIAM VIIS <br /> /OG 6 R:1DI. 3O� <br /> GARa6E � SAKE <br /> P3 � <br /> • a •133 t <br /> /OZ .2 N <br /> ti 16 <br /> • PS <br /> cA/ <br /> 6p' <br /> ki"WE ME 4r- glesh <br /> .�_ �Q0P�J4� xfNE Cf►Gi`+V <br /> 1,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)) NLVIN )?E/USOIV Certification No. 55- 1-5-36 <br /> Address R+Z 1616i351W7k wts, <br /> Name of installer if known /f'��Q/J //JJ <br /> Copy A— Local Authority CST Signature atdn ;%_ /�P�y),i�,•.� <br />