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=Om <br /> a1' -I D <br /> N a <br /> o 4 -- CL <br /> :3 A LN (D <br /> N N <br /> m � <br /> v r9 N <br /> O <br /> m O O <br /> y rn <br /> Lri <br /> �' ON TEST RATE O Z <br /> O 3 D <br /> 7 ADDRESS OR LOCAnaN �, _ cm: Wil' •�• fr 1�) 70 <br /> 3 OWNER NAME — <br /> _ , _. ---DATE:_��s.�� <br /> sL <br /> APN: APPLICATIONSr� 1(" DEPTH TO FIRST WATER: F, (n <br /> SOIL TYPE 'L.t. / S ;;0 <br /> REMARKS m <br /> a1 O <br /> r* LOCATION OF TEST HOLES ISHOW WELLS AND STRUCTURES) A r <br /> r+ <br /> N O <br /> (D <br /> n <br /> r r Cf J C( 1- 11 Cn C 11 ( II- <br /> • r <br /> SOIL PROFILE IF REQUIRED <br /> De th Soil Type Depth Soil Type Depth Soil T De th Soil T De th Soil T e <br /> Test Hole#1 b47-- _ Test Hole#2 _ <br /> Parcel' Diameter �: in Depth: 1 p �n I Parcel Diameter in 'Depth n <br /> TIME I READING WATER DROP REFILLED TIME READING I WATER DROP REFILLED <br /> PERCOLATION RATE: C) minlin PERCOLATION RATE: minlin <br /> RECOMMENDED SEPTIC AREA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: IWJ�=� l�ACL), Phonk ��s"w Date ! <br /> TEST CERTIFIED BY: Phone: Date <br /> OBSERVED BY(RENS): ��y�ir � � Phone Date ' <br /> PERC TEST RATE FORM <br /> EHD 42-03 REV 1112/09 <br /> n <br /> O <br /> CL <br /> 0 <br /> p1 O <br /> Dq O <br /> CO <br /> •A N <br /> -- - 00 <br />