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EH 115 Ray.g,7g - <br /> - - --nErOnT ON COIL oDnrND9 AND PCRCOLATION TESTS <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> rr11,�1�,�'� rr�••����� P.O.' BOX 309,MADISON,WISCONSIN 53701 " <br /> LOCATION:t^w'4,SW.,Section�,TL�d/,R_D(or))W',Township or Municipality `S �' to <br /> Lot No.�, Block No. M Q p @ 41 IYr r o h County At <br /> /I _.onon ami <br /> Owner's/Buyers Name: �0 PM's U S ' ti��p//P.'I <br /> Mailing Address: O a q C?r 'T P ' S L . � <br /> TYPE OF OCCUPANCY: Residence _A� No.of Bedrooms COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT g ALTERNATE SYSTEM—OTHER <br /> DATES OBSERVATIONS MADE: SOIL BORINGS •S- II 0 I 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- INCHES THICKNESS,N INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN <br /> BER 1STWE ED SWELLING INMINUTES PERIOD, PERIOD2 PERIODS <br /> u c P_ <br /> P_ <br /> P- <br /> SOIL BORING TESTS - <br /> TEST TOTAL DEPTH DEPTH TO GROUNDWATER,INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR, <br /> NUMBER INCHES OBSERVED ESTIMATED H IGHEST TEXTURE,MOTTLING AND DEPTH TO BEDROCK <br /> IF OBSERVED IN INCHES <br /> e- I 'b' - 7 e --$,t n <br /> e- •' " r - " e -SQA d 0 <br /> B_ a� rr �.� .: a ,t. .r 0 <br /> I. p <br /> GT r (9 <br /> B_ <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the pl the Iat and square feet of suitable areas. <br /> Indicate number of square feet of absorption area needed for building type and occupancy U' F Indicate scale or distances. <br /> Give horizontal and vertical reference points. Indicate slope. <br /> ll srry III z1 3e�( I C rle <br /> i o o ane LF <br /> p b E3 <br /> N <br /> I <br /> �Y' r� r RJar^P �� 6 �� 5 I /UE S4 ( /v..�i'�.r Q�•C�C <br /> I O 4.YJ4 r^` H <br /> 3 ) , c <br /> vim, <br /> ,r , o ', <br /> �� - / A � <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) C Certification No. -� 7 <br /> Address (Al ' r S' <br /> .Name of installer if known <br /> Copy A—Local Authority CST Signature <br />