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Address or Location: <br /> Owner: <br /> Application No. . Date: <br /> Depth to First Water: Size of Boring: g <br /> Soil Type: <br /> Remarks: <br /> Location of Test Holes (Show Wells & Structures) <br /> Soil Profile <br /> (If Required) <br /> 1. <br /> 2 . <br /> 3 . <br /> 4 . <br /> 5. <br /> 6. <br /> 7 . <br /> 8 . <br /> 9 . <br /> 10. <br /> TEST HOLE #1 TEST HOLE #2 <br /> Time Reading Water Drop Refilled Time Reading Water Drop Refilled <br /> 1 . /0 2. 1y , � . s� <br /> 3 , Iq , <br /> -7 <br /> 2 , <br /> Percolation Rate: 13 , 2 h7�/?, fih, Percolation Rate: <br /> Recommended Septic Area: 12 C Recommended Septic Area: <br /> 9 <br /> Test Performed By: <br /> Test Certified By: m <br /> i Exp. - YJ <br /> Observed By (Sanitarian) : c <br /> g*� <br /> Cl <br /> F:ISMMISOMIR. l9lC OF rC,' � / <br />