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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 /> P.O. BOX 309,MADISON,WISCONSIN 53701 <br /> LOCATION:SWJ %,—%,SectionN,RZA(or)W,Township orAAaaici ality <br /> Lot No._J `' , Block No. z' i Dom- County L<r✓r=// <br /> ivislon Name <br /> Owner's/Buyers Name: 'e--'- A—, - <br /> -� �� ' <br /> Mailing Address: 3�-3� ���• /Y. �7/n/�rl .�.�o ��sli �✓i� <br /> TYPE OF OCCUPANCY: ResidenceNo.of Bedrooms 12— /COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW x REPLACEMENT ALTERNATE SYSTEM OTHER <br /> DATES OBSERVATIONS MADE: SOIL BORINGS/e—_?—;7 PERCOLATION TESTS A 2P <br /> SOIL MAP SHEET NAME OF SOIL MAP UNIT <br /> PERCOLATION TESTS <br /> TEST DEPTHCHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL,INCHES RA <br /> NUM- SINCE HOLE HOLE AFTE TE <br /> INCHES THICKNESS IN INCHES INTERVAL MINTS <br /> BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 <br /> T 7- <br /> P3 (-:C re u y 67 <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 /> TEXTURE,MOTTLING AND DEPTH TO BEDROCK <br /> NUMBER INCHES <br /> OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES <br /> B- q G/( <br /> B_ <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on th I n the locati nand square feet of suitable areas. <br /> Indicate number of square feet of absorption area needed for building t occupancy j <br /> q p g ype and occu anc � ..� ,Indicate scale or distances. <br /> Give-horizontal and vertical reference points. Indicate slope. <br /> cls//� i c�• 4 C?�E <br /> N <br /> y, 7 <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 (prin � � � � /— � Certification No. <br /> Address <br /> Name of installer if known / <br /> Copy A— Local Authority CST Signature,,/27'tf t � / <br />