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.'. Telephone:i20 .__ Fnx� „•y. <br /> PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: / � - <br /> OWN ER NAME: h�' _- ly <br /> APN• L'3 - _APPLICATION p: - DA 4 <br /> SOIL TypE FIRSTWAT <br /> REMARKS: <br /> LOCATION OF TEST HOLES(SHOW WELLS AND STRUCTURES) <br /> PERCOLATION TEST SKETCH I _ PERCOLATION TEST SKETCHi <br /> 1., -NA.F\DIC PIPE <br /> `7��1•,`I, 4-IN DLA.SOIL BORING i I I ct 2-N DIA.PVC P@& <br /> I-Iti DIA.SOIL BORNG <br /> i <br /> -T- — <br /> I R1:FILL I IIi1,II I I <br /> —' -7--REfll.L HEIGHT - <br /> ! ..I <br /> SOIL PROFILE IF REQUIRED) <br /> Depth Soil Type Depth TSoiI Type I Depth I Soil Type Depth Soll Tyke Depth Sei1 Type <br /> Test Hole#1 Test Hole#2 <br /> Parcel: Diameter: n Depth, iParcel: Diameter in Depth <br /> Test READING WA r:F DR, REFILLED Tim= RFr0'.14,, V.r.•Di.,, R- <br /> U S 1-11 c 7l K <br /> IN 3 ;' � � c I ?,'7 7 M1 <br /> i 5 3,112 !I•.i ya y <br /> 3 7 <br /> ] <br /> min/in PERCOLATION RATE:_-- t.'>_—_--_minlin <br /> PERCOLATION RATE:—__ - ----- RECOMMENDED SEPTIC AREA: —_— __- <br /> RECOMMENDED SEPTIC AREAJ_--__-------- Phone: = Date %sem/ <br /> TEST PERFORMED BY: _—_— Phone: __---__ _—_ Date --__--__ <br /> --- <br /> TEST CERTIFIED BY: ----------- - Phone_— Date <br /> OBSERVED BY(RENS):_--------------- PERC TEST RAI F F <br /> EI ID 42-03 ItLV 1 V2ro9 <br /> Naseem Ahmed, Environmental Health Specialist <br />