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EH115 Rev.9/78 <br /> REPORT ON SOIL 90RINGS AND PERCOLATION TESTS <br /> WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES <br /> �`� P.O.� BOX 309,MADISON,WISCONSIN 53701 <br /> LOCATION:�11 %,�'/e, Section ,T_&N, &Q (or)W,Townnsship or Municipality pa fi ^ 4 t/ cY <br /> Lot No. , Block No. C 'P' 's-u �`'' County t7 uP H P <br /> - .S� - d S bdi,6lslon Name <br /> Owner's/Buyers Name: /O Vve, C//L c <br /> Mailing Address: & C 4 t JV 14 4 4 F C t J T << k. h <br /> TYPE OF OCCUPANCY: Residence �< No.of Bedrooms COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT sp ALTERNATE SYSTEM OTHER <br /> DATES OBSERVATIONS MADE: SOIL BORINGS .. �-' o U 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- SINCE HOLE HOLE AFTE INTERVAL - MIN/IN <br /> BER INCHES THICKNESS IN INCHES 1ST WET ED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 <br /> P— 1 X18" <br /> P— 'a- y 8" r r I / I / � C / C l / <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 /> NUMBER INCHESTEXTURE,MOTTLING AND DEPTH TO BEDROCK <br /> OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES <br /> aA <br /> B— 8 •r // nrr " C 4 t ) ° I' 1, qj <br /> 0ay, ziY" Sr L r fl <br /> B_ n �" C 4 <br /> B- $ Y 8y " H , „ C 0. � L S' y <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the pi the loWion d square feet of suitable areas. <br /> Indicate number of square feet of absorption area needed for building type and occupancy /0 F .Indicate scale or distances. <br /> Give horizontal and vertical reference points. Indicate slope. <br /> �0y• i� l <br /> r 6f SP rs--/ce 1 I Q <br /> � — k I fo <br /> t n /VUR <br /> ARrT' Or <br /> N <br /> pC c r r'lO r ,vi /c l f�7/� 7 f}'. b p1..p. <br /> Q C.ki <br /> rrc :a� b'l�l ,re }� e (.rs _ !�f© 1 4,o 7`' 4/. <br /> � t, C Ir^C/// � d7c so o' 1\l t,?- 7- . �° u t /cote RrsorT <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 /> j� <br /> Name (print) I ' d r I c� i�P n S, Certification No. y 7 <br /> Address W� '1' r- / 1 . 'r'4'c'�9, t� <br /> Name of installer if known / <br /> Copy A— Local Authority CST Signature <br />