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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br />` 600 East Main Street, Stockton, CA 95202-3025 <br /> • Telepharte: (209)468-3420 Fax-'(209)464-0138 Web.www,sjgov.org/ehd <br /> PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: I o-•S o CITY: <br /> OWNER NAME: !N� ATE: <br /> APN: 20-+ `IAPO-Q4 a --o(D APPLICATION I: PN -•10 0 0 t too DEPTH To FIRST WATER: R <br /> SOIL TYPE: <br /> REMARKS: <br /> LOCATION OF TEST HOLES SHOW WELLS AND STRUMIZEs <br /> PERCOLATION TEST SKETCH PERCOLATION T$ST SKETCH _ <br /> 2-INDIA.PVC PIPE! ` 2-IN DIA PVC PIPET <br /> 4-IN DIA.SOIL BORING 4-IN DIA SOIL.BORING <br />' — <br /> �— i FILLMGHT <br /> _ REI�ILLIIEIGI3T �. � RE_ •-- _ --- _ <br /> SOIL PROFILE F REQLIIitED <br /> Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil T e Depth . Soil T <br /> Test Hole#I Test Hale# 2 <br /> Parcel: Diameter: in I Depth, ire I Parcel: Dlameter. in Dept min <br /> TIME REROING WATER DROP REFILLED TIk4E, REAomo WATERDROP RFFILI-ED <br /> 4, __-- <br /> l di° <br /> ..� <br /> At JL <br /> :•�,./ - .r/� 0 ids <br /> -3-5 D <br /> i ,m.,.+ <br /> PERCOLATION RATE: ` 1; - -_mintin PERCOLATION RATE:_— SA F — rr�inlin <br /> �"�,RECOMMENDED SEPTIC EAi RECOMMENDED SEPTIC A EA: _ <br /> E ;TEST PERFORMED BY: / _ Phone: <br /> TEST CERTIFIED BY: _ _ _ Phone: 3 �d 6 { Date ------- <br /> OBSERVED BY(RENS): r f - _ <br /> Phone _ Date - <br /> EHD 42-03 REV 1112109 PERC TEST RATE FORM <br />