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LADDRESS OR LOCATION: U `'hA'�S 900%%„ APN: / Q <br /> OWNER: fi� oW 5G3. �A Vwl5 DATE: <br /> LAPPLICATION #: DEPTH TO FIRST WATER: It SOIL TYPE: <br /> 4hour test lhour hot <br /> REMARKS: t7 301(12'Last Water Drop) to t(12*Last water Drop) <br /> Deep less than or-n miNin <br /> L, LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) s Shallow less than or=60 win <br /> L <br /> L <br /> LSOIL PROFILE (IF REQUIRED) S,OQ <br /> Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type <br /> L <br /> TEST HOLE #1 DIAMETER: in DEPTH: �'_ in TEST HOLE #2 DIAMETER: In DEPTH: In <br /> b. <br /> WATER <br /> TIME READING DROP WATER REFFILLED TIME READING DROP REFFILLED <br /> to �7 pyy <br /> /a v11 5-134/ .S3 41. 89' <br /> /t /7 <br /> 6. <br /> la 17 S�4 t 3`1 �It 73 <br /> 1 -7 s, til y► yy <br /> ;W7 <br /> PERCOLATION RATE: 69 min/in PERCOLATION RATE: min/in <br /> RECOMMENDED SEPTIE AREA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: i ✓ Phone: Date: <br /> TEST CERIFIED BY Phone: .L�3Date: f I— U-U _ <br /> OBSERVED BY(REHS): Phone: Date: <br /> EHD 42-02-003 PERC TEST RATE FORM]c <br /> REVISED 5/7/02 <br />