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OWNER: Cly; �� �,�� DATE: _ 7 <br /> APPLICATION #: DEPTH TO FIRST WATER: it SOIL TYPE: <br /> 4hour test 1 hour test <br /> Ff REMARKS: 301l12'LastWat�erMap) "01)112 LasiWarerDmp) <br /> deep less Than or=30 minfin <br /> LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) F shallow less lhanor=8ominfin <br /> { <br /> E_ <br /> SOIL PROFILE (IF REQUIRED) <br /> Depth Soil Type pth Scii Type Depth Soil Type Depth Soil Type Depth Soil Type <br /> 6 -15 <br /> i <br /> TEST HOLE #1 DIAMETER:in DEPTH:132--tri TEST HOLE #2 DIAMETER: In DEPTH: in <br /> EMEREADING WATER REPFLLLED TIME READING WATERREFFILLED <br /> DROP DROP <br /> �Y s 1 <br /> -02 <br /> q _2 <br /> r e -- qt <br />� yz <br /> Dg 010D <br /> 030 D3 0 y� Z71, <br /> PERCOLATION RATE.: y min/in PERCOLATION RATE: Tnin/in <br /> �tRECOMMENDED SEPT AREA: RECOMMENDED SEPTIC AREA: <br /> F, r <br /> TEST PERFORMED BY: ZPhone: !0 — .� Date: '3 Q <br /> FTEST CERIFIED BY: Phone: Date: <br /> OBSERVED BY(KERS): = Phone: �6 ��� Date: <br /> EIM 42-02-003 PERC TEST RATE FORMIc <br /> REVISED 5/7/02 r <br /> Gr i <br /> 5 <br />