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E 15 Rev. 9/78 <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 />LOCATION:,'/0, 1/4, Section((T_�LN,R14_15�(or) W, Township or M el+ty <br />Lot No. , Block No.County <br />r�'++ ul�vision ame <br />Owner's/Buyers Name: <br />�(A-Ci o v^Cl— `L'► CC-, <br />Mailing Address:_ J `� 'fC� �' Sia 10'1Pir�l elJ �.z� C_ 01 i <br />TYPE OF OCCUPANCY: Residence 25— No. of Bedrooms 2 COMMERCIAL <br />EFFLUENT DISPOSAL SYSTEM: NEW �� REPLACEMENT ALTERNATE SYSTEM OTHER <br />DATES OBSERVATIONS MADE: SOIL BORINGS 3-1 - SS PERCOLATION TESTS 41 - Z <br />SOIL MAP SHEET <br />NAME OF SOIL MAP UNIT <br />PERCOLATION TESTS <br />TEST <br />DEPTH <br />CHARACTER OF SOIL <br />HOURS <br />WATER IN <br />TEST TIME <br />DROP IN WATER LEVEL, INCHES RATE <br />NUM- <br />INCHES <br />THICKNESS IN INCHES <br />SINCE HOLE <br />HOLE AFTEF <br />INTERVAL <br />MIN/IN <br />BER <br />1ST WETTED <br />SWELLING <br />IN MINUTES <br />PERIOD 1 PERIOD 2 <br />PERIOD 3 <br />P- <br />B_ 5f <br />Z <br />c <br />1 <br />P- <br />P- Z <br />L. <br />( <br />O <br />P- <br />C i <br />SOIL BORING TESTS <br />TEST <br />NUMBER <br />TOTAL DEPTH <br />INCHES <br />DEPTH TO GROUNDWATER, INCHES <br />OBSERVED ESTIMATED HIGHEST <br />CHARACTER OF SOIL WITH THICKNESS, COLOR, <br />TEXTURE, MOTTLING AND DEPTH TO BEDROCK <br />IF OBSERVED IN INCHES <br />B— .Z <br />B- <br />B_ 5f <br />Z <br />c. <br />_, <br />5 <br />ULAN V ILW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. <br />Indicate number of square feet of absorption area needed for building t (a r <br />q p g ype and occupancy __ 4 «' Indicate scale or distances. <br />Give horizontal and vertical reference points. Indicate slope. 'Cj 7L, <br />Ye' -4L Av a'i -( Io <br />x 1 <br />iw L �'.IZ,Cx C oC)"P <br />r�.'.�. <br />I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and meth ds <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) LQ4L ':- 5 (% <br />Address 00 13 <br />Name of installer if known <br />Certification No. ( C- 7 <br />Copy A —Local Authority CST <br />