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1 EH 115 FI 9178 <br /> REPORT ON SOIL BORINGS AND PERCOLATION TESTS <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> P.O. BOX 309,MADISON,WISCONSIN 53701 <br /> r <br /> ' ,fC,sJ/S <br /> LOCATION:�'/.SG '/.,Sectiones ,T�N,ry=�blorl W,Township or Municipality S <br /> Lot No.--�(—/ —, Block No. _4 5!Y/,- SL✓/SS /// County <br /> County <br /> Subdivision am- ee <br /> Owner's/Buyers Name: 2" /7 C/rr r' .✓ 1.< r <br /> ( Mailing Address: •1 7C �" �d-[ 6iC" .Sf �t /Yl ^-��/ <br /> TYPE OF OCCUPANCY: ResidenceNo.of Bedrooms COMMERCIAL <br /> 1 <br /> EFFLUENT DISPOSAL SYSTEM: NEW—REPLACEMENT ALTERNATE SYSTEM OTHER <br /> DATES OBSERVATIONS MADE: SOIL BORINGS" '--2-72! PERCOLATION TESTS 41-'�'�—' � <br /> SOIL MAP SHEET NAME OF SOIL MAP UNIT <br /> PERCOLATION TESTS <br /> kUM <br /> OFPrH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHESRATE f <br /> INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTELING INTERVAL MIN/IN <br /> ISTWETTED SWELLING IN MINUTES PERIOD( PERI002 PER1003 I <br /> y <br /> doI <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 JESTIMATED HIGHEST <br /> IF OBSERVED IN IN <br /> B- <br /> I <br /> B— <br /> B— <br /> PLAN VIEW(Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the Ian the Iota 'on ands ware feet of,suitable areas.111111 <br /> Indicate number of square feet of absorption area needed for building type and occupancy Indicate Indicate scale or distances. <br /> Give horizontal and vertical reference points. Indicate slope. _ p <br /> O /f{ F�.C� <br /> v <br /> I <br /> I <br /> I <br /> a <br /> rF° I <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\t holes are correct to the best of my <br /> knowledge and belief. <br /> Name (printd "�C•�� 1�1�,t6'i CertifIN\ No. \,e <br /> No- <br /> Address /J /./E.Sr � C✓[ r.: .3'T 4%3 - N� , <br /> .Name of Installer If known •,"A <br /> _ Copy A1 of Authority CST.Signature/Ir <br />