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a�a�•IK, SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �.. --Ir. .•a <br /> • [ ` 600 East Main Street, Stockton, CA 95202-3029 <br /> ' Telephone., (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.orglehd <br /> PERCOLATION TEST RATE / <br /> ADDRESS OR LOCATION:� 1V /y—: 7 ///-d- p/)j f CITY: <br /> OWNERNAME:_Civ th •Ghilet / 4;y—G Loe�.w� DATE: y_ <br /> APN: J�x APPLICATION#:����B��I DEPTH TO FIRST WATER: Ft <br /> SOIL TYPE: <br /> REMARKS: <br /> LOCATION OF TEST HOLES(SHOW WELLS AND STRUCTURES <br /> PERCOLATION TEST SKETCH — <br /> PERCOLATION TEST SKETCH I <br /> 2-INDIA.PVC PIPE/ 2-IN DLA.PVC PIPE/ <br /> 4•IN DIA.SOIL BORING ( I 4-IN DIA SOIL BORING <br /> a , <br /> i <br /> RBFILI,HEIGHT 1 I ; I 7 REPII,L HEIGHT . <br /> .. ...E........ ........... __'L 1 1- 1.....FTI <br /> - _. .....___ ........__.I <br /> - -.. _ _ <br /> • SOIL PROFILE IF REQUIRED <br /> Depth Soil Type Depth Soil Type 1 Depth Soil Type I Depth I Soil T e De th SOil Type <br /> Test Ho #1 Test Hole#2 <br /> Parcel: Diameter: n Depth: / Parcel: Diameter: In I Depth: <br /> TIME READING WATERDROP REFILLED TIME READING WATER DROP REFILLED <br /> 9!/& hyv �Z <br /> U O b <br /> LA6 <br /> L <br /> ' b <br /> PERCOLATION RATE: ___ _} minlin PERCOLATION RATE: minfin <br /> RECOMMENDED SEPTIC REA: _ _ RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: _ Phone:yjZ_809Z _ Date �� <br /> TEST CERTIFIED B Q _ Phone: i=0(q ! Date (Q <br /> OBSERVED BY(R ): _ _ _ Phon2o !3-761$ Date 6 <br /> • EHD 42-03 REV 1UM9 <br /> RC TEST RATE FORM <br />