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ALJUht55 Urs LUUAI I/U�IN: ' 70 Z-1 �- d ANN: <br /> OWNER: '_ w DATE: <br /> APPLICATION #: DEPTH TO FIRST WATER: ft SOIL TYPE: <br /> 4 hour test 1 hour test <br /> yREMARKS: j? > —S�i,��fi`�—S C /--s C� .,�; %�j(� f —s 30/(12'LastWaterDrop) 101(12'LastWater Drop) <br /> Deep less than or=30 min/in <br /> LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) a Shallow less than or=60min/in <br /> SOIL PROFILE (IF REQUIRED) �'7 <br /> Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type <br /> —TEST HOLE #1 DIAMETER: in DEPTH: _ TEST HOLE #2 DIAMETER: In DEPTH: in <br /> WATER <br /> TIME READING DROP REFFILLED TIiti1E READING DROPWATER REFFILLED <br /> 00 fir , S6 <br /> 200 <br /> Lo/00 <br /> r <br /> "'PERCOLATIO RATE: y / min/in PERCOLATION RATE: min/in <br /> RECOMMENDED SEP RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: /L'�✓ Phone: �� ' ���- Date: <br /> z— <br /> TEST CERIFIED BY: Phone: Date: <br /> OBSERVED BY ( ,_ _ Phone: --6 Date: <br /> EHD 42-02-003 ° PERC TEST RATE FORM Ic <br /> REVISED 5/7/02 <br /> L <br />