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ADDRESS OR LOCATIOi1 <br /> OW ri E R <br /> APPLICATION NO. DATE ? � � SOIL PROFILE <br /> ( IF REQUIRED.) <br /> DEPTH TO FIRST WATER : SIZE OF BORING : <br /> 1 " <br /> SOIL TYPE : <br /> L <br /> REMARKS : <br /> LOCATION OF TEST HOLES (SHOW WELLS & STRUCTURES) 3 " <br /> 4 " <br /> C� = 1Zi7 ' t. <br /> a • <br /> 1� <br /> TEST HOLE is 1c f C.PTEST HOLE 42 <br /> i <br /> TIME READING WATER DROP REFILLED TIME READING WATER DROP REFILLED <br /> i <br /> �/)-Ou 003 :b� � .4s 0 . z-3 <br /> 0. 03 1 . 3 [ .93 b_ 2-9 <br /> -- 1 <br /> Ic yt <br /> ©. Dr . 214 <br /> PERCOLATION RATE- <br /> w, PERCOLATION RATE: j <br /> RECOMMENDED SEPTIC AREA: RECOMMENDED SEPTIC AREA: j <br /> i <br /> TEST PERFORMED 'BY: <br /> TEST CERTIFIED BY: X-4 <br /> OBSERVED BY (SANITARIAN) � <br />