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EH115 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:):11., E'/<, Section ,T_/&N,R_ Herd?TownshiP OP44mieipelky f-,-) T7- <br /> Lot No. , Block No. —, County 'o""P �Tl <br /> ub wlslon ame <br /> Owner'sA Name: AIA /'f DL I) S[/./f jit/27ZZ0U." <br /> Mailing Address: ;79a �L6'e 'ail bk"L,4r r /PC a /</=e'e0 +U Z 6116Y <br /> TYPE OF OCCUPANCY: Residence X NO.of Bedrooms a'- COMMERCIAL <br /> EFFLUENT DISPOSAL SYSTEM: NEW_REPLACEMENT ALTERNATE SYSTEM—OTHER— <br /> DATES <br /> YSTEM OTHERDATES OBSERVATIONS MADE: SOIL BORINGS 'ILIX �f M0 PERCOLATION TESTS J1, 4,e �yfy <br /> SOIL MAP SHEET NAME OF SOIL MAP UNIT <br /> PERCOLATION TESTS <br /> M <br /> CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHE RATE <br /> THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVALMIN/IN <br /> 1STWETTED SWELLING INMINUTES PERIOD1 PERIOD2PERIOD3SEE �:�2 (i rNd .j /A rr� Q 3P- <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 ESTIMATED <br /> HIGHEST IF OBSERVED IN INCHES <br /> B- '.Z 1 / s2 Z 7 Je O s :9 <br /> B- .L A 11 73- /_ s. ��- <br /> B- 3 21 7 <br /> e- — 7. BZ A ;( <br /> B- j- I - ;-.s /- /-s s <br /> B- 7a <br /> PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan 1e location and square feet of suitable areas. <br /> Indicate number of square feet of absorption area needed for building type and occupancy O .Indicate scale or distances. <br /> Give horizontal and vertical reference points. Indicate slope. <br /> r � <br /> To d7// A / Seo r <br /> Tv NEA�FS T ♦ - B4),Q e <br /> I &DG, t /� t,rJN.TE OAK e _ E«UATor/ <br /> � h <br /> /`iXL'4 i Iao, <br /> ;A t' <br /> N <br /> /o <br /> (,j7T,4NL <br /> uASD <br /> WA <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) CEG.L S'c./2r�&Xte Certification No. <br /> Address hA 1 'S-229 <br /> Name of installer if known clA rl <br /> Copy A— Local Authority CST Signature <br />