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ADDRESSOR LOCATION: 4 °2 e l miyh� ti A APN: 25 O - 16() - bk'. -o°I f -(( <br /> QChP;�"1 <br /> .. OWNER: )CACI -4 DATE: V21.1I05 <br /> APPLICATION #: DEPTH TO FIRST WATER: ft SOIL TYPE: t 5. <br /> ��� 1 �. 4homtest 2'LastI hour est <br /> Water <br /> REMARKS: - O1.'E �- Z 3o1(iz•LastwalerDrop) Iorhz•�aslwalerDrop) <br /> Deep less Ihan or=30 min(n <br /> LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) a Shalbw le smart or= miNin <br /> 3 .1 <br /> SOIL PROFILE (IF REQUIRED) <br /> Depth Soil Type Depth Soil Tye Depth Soil Type Depth Soil Type Depth Soil Ty e <br /> r <br /> TEST HOLE #1 DIAMETER: In DEPTH: y2 In TEST HOLE #2 DIAMETER: ID DEPTH: In r <br /> WATER <br /> TIME READING DROP REFFILLED TIME READING WATER DROP REFFILLED <br /> >.2.'A <br /> 210 15 .5`� -5`1 S,2ty <br /> �Z <br /> . <br /> 53 <br /> 2' 40 r,- ,S-3 <br /> 2: 50 11 <br /> 2S <br /> nip <br /> PERCOLATION RATE: , 3 ' J. J min/in PERCOLATION RATE: min/in <br /> RECOMMENDED SEPTIC AREA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: G �, Phone: Date: <br /> ` TEST CERIFIED BY: Phone: , -7- 370 1 Date: -OJ^ <br /> OBSERVED BY (REHS): ,4 C n : Phone: Date: /u2 ✓'Cl <br /> r <br /> EHD 42-02-003 - PERC TEST RATE FORM I c <br /> REVISED 5n102 <br />