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UWNER ,, ft' 'far•-/,./ s�7�S ,AUUkE55 Uf2 LU( AI lUl� 3 41Au <br /> P.M. or S. NUMBER: a U-SZ — � DATE: � "5 <br /> DEPTH TO FIRST WATER _SIZE OF HOLE: SOIL PROFILE r/z ( IF REQUIRED) i <br /> SOIL TYPE: <br /> f, <br /> 21 <br /> REMARKS: 3' _C7r.,��• - <br /> q1 <br /> LOCATION OF TEST HOLES ON PROPERTY 5' <br /> (SNOW ANY WELLS AND STRUCTURES) 61 - <br /> 7 <br /> r 8 5 <br /> jc�G 4ucwa�VH d+, �1 ? _ <br /> A7r <br /> FJN4Ye�w! n� R/fip up <br /> I/VLZ 70 i&,C .SAtKf�q <br /> %v/4,22 c L- •- AAF <br /> Rss�� <br /> --d_ E �� <br /> A 0-70S 77 CP <br /> 1rr,.L A, <br /> `/.S DIA. <br /> w/Z.S�Di.4 P•NL <br /> AD7r sr _ H. <br /> 5—L {a <br /> I <br /> � r j <br /> TEST HOLE #I TEST HOLE 92 <br /> TIME READI-N —VATUR7D RO P REFILIED TIME R REFILLED <br /> 9 C, 7 - r <br /> 3, <br /> �.3 <br /> PERCOLATION RATE : / . 2 '"" ` •moi PERCOLATION RATE: <br /> RECOMMENDED SEWAGE DISPOSAL AREA: RECOMMENDED SEWAGE DISPOSAL AREA: ' <br /> Ga 0 i j t <br /> a <br /> TEST PERFORMED BY: L_. --:,. , , <br /> TEST CERTIFIED BY: a. �-- <br /> OBSERVED BY (SANITARIAN) r or R. S. N)�__�'`/� � <br /> [it 13 11 3 <br />