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ADDRESS OR LOCATION: ��� - �^^ �Z APN: <br /> OWNER: �� �"�^ DATE: Vii• Z77 O to <br /> APPLICATION #: DEPTH TO FIRST WATER: ft SOIL TYPE: <br /> ` 4 hour test 1 hour test <br /> REMARKS: /[ r� 30l(12 Last Water Drop) 101112'lastWaterDropl <br /> Deep leu than cr-30 minlin <br /> LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) sauawlesstharl=160 mm <br /> FAL-u -- I I I I I 1±17-71±±----i I Tluat--u <br /> MOM <br /> SOIL PROFILE (IF REQUIRED) <br /> De th Soil Type Depth Sth oil T e De Soil Type Depth Soil Type Depth <br /> Soil T e <br /> TEST HOLE#1 DIAMETER: In DEPTH: In TEST HOLE#2 DIAMETER: In DEPTH: In <br /> WATER < II WATER <br /> TIME READING DROP REFALED TIME READING DROP REFFILLED <br /> t;~b Jz- <br /> I <br /> , moo S . i <br /> ` I � 2. <br /> I2� <br /> 0 v 5 L] b < <br /> I < Z <br /> a�1 <br /> PERCOLATION RATE: 4• i -min/in PERCOLATION RATE: min/in <br /> RECOMMENDED SEPTIC A RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: e ----Phone: �� . zi�-o t Date: 3 Z3• o(P <br /> TEST CERIFIEDBY: Phone: -367-`j20 ( Date: <br /> OBSERVED BY (REQ 6 Phone: ���='y Date:' <br /> EHD 42-02-003 PERC TEST RATE FORM Ic <br /> REVISED 5/7/02 <br />