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O (D <br /> -1 f D > <br /> > 0 <br /> Lu (D <br /> U) <br /> 7 <br /> 0 <br /> M 2. � 0 <br /> :3 0) M <br /> L71 <br /> 0 > <br /> Fi4n4AVIIIA w <br /> M <br /> (D (A <br /> M (D <br /> ADDRESS OR LOCATION <br /> =r <br /> OWNERNAME: II /'2' C' DATE: /�A, <br /> (D <br /> APPLICATION a: —DEPTH TO FIRST WATER: r+ <br /> 0 <br /> SOIL TYPE. <br /> REMARKS- J _p 77 <br /> 0 <br /> :3 <br /> (D I <br /> M <br /> LOCATION OF TEST HOLES fqWnW WELLS AND STRUCTURES-r� - ) <br /> N. F11 'Fill -IT-[!] � rn F F <br /> F-1 <br /> SOIL PROFILE IF REQUIRED 7-7.1_77771 <br /> De t Soil Type Depth A20 ip_!� De I 11 boll M)", il_Type_ <br /> — <br /> Test Hole#I H 3 F est Hole#2 in <br /> —P.r—.1 Diameter. n De th- <br /> fATER DRO D T READING REFILLED <br /> TIME READING <br /> L/ 3 <br /> C, <br /> 9 _43 0,03 ........ <br /> . <br /> 79 <br /> fi v.L <br /> -1 3 7' - , -1 1—13 TS- <br /> SL <br /> 63 <br /> 1030 <br /> C)A63 <br /> 4, OS- 1225 3 7�� <br /> 3,7 <br /> C),C, <br /> /v5 o :3 .7-i <br /> 7.i <br /> PERCOLATION RATE: minlin PERCOLATION RATE: minfin <br /> RECOMMENDED SEPTIC AREA: <br /> RECOMMENDED SEPTIC AREA: <br /> Phone: Date <br /> TEST PERFORMED BY: Phone: Date <br /> TEST CERTIFIED BY: Phone— Date <br /> OBSERVED BY(RENS): PEFIC TEST RATE FORM <br /> CHO 4243 REV 11009 <br /> (D <br /> 0 <br /> to <br /> fD �i <br /> 0 <br /> 00 <br /> 0 <br /> NO <br /> 00 <br />