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ADDRESS OR LOCATION: `r okt I1h ` ckoo� APN: <br /> OWNER: DATE: <br /> APPLICATION #: DEPTH TO FIRST WATER: ft SOIL TYPE: <br /> E(12 <br /> 1 hour test <br /> REMARKS: WaterDrop) 10/(12'Last Water Drop)ess than 30 deep must be less than 30LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) e less than 60 shallow must be lessthan60 <br /> �e <br /> FF <br /> �� i " Z - � <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: `i in DEPTH: q1 in TEST HOLE #2 DIAMETER: Lj in DEPTH: in <br /> TIME READING WATER DROP REFFILLED TIME READING WATER DROP REFFILLED <br /> .'2 1 <br /> �3 Ngi. 1 C-I .�2=3� <br /> PERCOLATION RATE: min/in PERCOLATION RATE: min/in <br /> RECOMMENDED SEPTIC AREA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: { O 1,,,,,� Phone: ��1 -��1�3 Date: Itl -05 <br /> TEST CERIFIED BY: Phone: Date: <br /> OBSERVED BY(REHS): Phone: Date: <br /> EHD 42-02-003 PERC TEST RATE FORM I c <br /> REVISED 5/7/02 <br />