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ADDRESS OR LOCATION: I Y I_ .IUrnYl{' >GS�rI I APN: <br /> OWNER: DATE: 1 �S <br /> APPLICATION #: DEPTH TO FIRST WATER: ft SOIL TYPE: <br /> REMARKS: r Y ��� 30 12est l0/(12hourtest <br /> � 301(12'Last Water Drop) 101(12'Last Water Drop) <br /> deep must be less than 30 deep must be less than 30 <br /> �rc.Rl LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) shallow must be less than 60 shallow must be less than 60 <br /> I'Ilk <br /> SOIL PROFILE (IF REQUIRED) <br /> Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type <br /> TEST HOLE #1 DIAMETER: L. In DEPTH: 92 in TEST HOLE #2 DIAMETER: in DEPTH: in <br /> TIME READING WATER REFFILLED TIME READING WATER REFFILLED <br /> DROP DROP <br /> I <br /> 5, 2� <br /> Cf � 33 S. Y <br /> ►? ' o S� 1 <br /> i2 20 �;.cn, <br /> ica•^°`.�.__�="�'. �ems: ;����. <br /> PERCOLATION RATE: min/in PERCOLATION RATE: min in <br /> RECOMMENDED SEPTIC AREA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: v Phone: -7'i1-5_�(A Date: <br /> TEST CERIFIED BY- Phone: --'_170 i Date: <br /> OBSERVED BY Phoa0�1 ����-31�'S Date: <br /> EHD 42-02-003 PERC TEST RATE FORM Ic <br /> REVISED 5/7/02 <br /> �. <br />