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OWNER: l�U(G� � !/`/ r(KCi�% DATE: <br /> APPLICATION n: DEPTH TO FIRST WATER: `t SOIL TYPE: <br /> 4 hvur fest 1 hour test <br /> i ,� REMARKS: 3x/112 Lastkiararop} 101i12'Ladkteror4pl <br /> — Deep less ihan or=30 minlfn <br /> LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) sha�lonEessthanor=fi0minm <br /> ft '71- <br /> M <br /> i, <br /> SOIL PROFILE (IF REQUIRED) <br /> Depth Soil Type Depth Soil Type Depth Soil Type Depth So�—ITyp e Depth Soil Type <br />! 1 <br /> k <br /> TEST HOLE#1 DIAMI=TER: in DEPTH: 3. TEST HOLE #2 DIAMETER: in DEPTH: in <br /> t ! TMTF- READING WATER REFFILLED TIME READENG WATER REFFLLLED <br /> DROP DROP <br /> d ZY, 99 <br /> S7 <br /> 661z-1I <br /> PERCOLATION RATE: 7 / min/in PERCOLATION RATE: rnin/in <br /> RECOMMENDED SEP AREA: RECOMMENDED SEPTIC AREA: � <br /> ! TEST PERFORMED BY: Phone:—,'&-„Aygz— Dater 13- 0 / <br /> y <br /> TEST CERIFEED B Phone: 5-' 7 3 fC'? Date: <br /> OBSERVED BY (REHS):f Phone: q6 9 `y 6 Date: � / 310I <br /> � FHD 42-02-003 ! PERC TEST RATE POFZMlc <br /> REVISED 5/7102 <br /> ! Y <br />