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ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,S a� <br /> tackton,CA 952p5-g2 ? f <br /> r4i Ph'NN�- Telephone:(z09)4883420 Fax:12091 464-01 38 <br /> Web:`N'MNs(gov orglehr] '� - � - <br /> PERCO <br /> CATION TEST RAT[ '. <br /> ADDRESS OR LOCATION; CAI C j <br /> �1?EL'7 W Ati E -- <br /> OWNER NAME: {z- <br /> �I IvtRR'T1�1 ------ _clTv: —z�o—N-c <br /> 2 <br /> APN: 2-1".. (l<"p 1 DATE: 7 Z Z t <br /> SOIL TYPE APPLICATION c 5g DO13(0 L(C{ FR- <br /> S'1+� GLS 1OAµ od�,l, 0.I --DEPTH TO FIRST WATER'. <br /> REMARKS _ <br /> LOCATION OF TEST HOLES(SHOW WELLS AND STRUCTURES <br /> PENCO"11IW TEST SKOU4 ,.. :—• <br /> 2'Dl—w Pvc Pb. "--' - PERffiUTIrIN iFSf SItETCM �.—.•. _, <br /> E'Di..met.r PyC Plpy <br /> 3.30 IL L10 - <br /> . (� 5.1.2 - <br /> -- — 2.5Z <br /> — Retili level: q-32-- `1. —lg ` —$ - J'1.17'gravGl <br /> — ` — 4...i rtele lercl: - 'r- <br /> - <br /> SOIL PROFILE(IF REQUIRED) <br /> De th Soil T e Depth Soil T e De th I Soil T Depth Soil T e De th Soil T <br /> ype <br /> 0-3.4: 0—2.Tz r.14- <br /> Test Hole#1 Ho Test Hole#2 j';old <br /> Parcel: Diameter: 14in De the 3. kp1rceFjL6j Diameter: in-Depth Z.52- <br /> TIME READING WATER DROP REFILLED TIME READING WATER DROP I REFILLED <br /> 10:00 Lt.2q Io:08 p, 4.63 <br /> 10.30 g . ( 4.3 — <br /> 11 :00 q.N,-7- .I 4. <br /> 1:30 4.Lf Z15 12:DS D,, 4.4 <br /> 12;00 4.-1(4 Li.32 12: 1 •6 .23 <br /> 12:30 4 c4 _ .l6 •311 12::z9' 1 Lf.5 <br /> 1:00 4. Lf$ [ Cf. 1235 4.75 4.q <br /> 1:30 4. 51 . 17 1 1Z:KS 4 .66 . 14. L{.5 i <br /> 2:00 .4 •16 - r2�Ss 4.�6 z 41 170 <br /> OLATION RATE: r S. 3 minlin PERCOLATION RATE: <br /> MENDED SEPTIC AREA: RECOMMENDED SEPTIC AREA: <br /> ERFORMED BY: Phone:(2.0q) 3 6Cf- Date 2-4 2-1 <br /> ERTIFIED BY: Phone: Date <br /> VED BY(REHS): 1 .�ir5{,/�l` !� Phone( <br /> 2C y -3y�`' Date z 1 <br /> 3 REV 11/2/05 PERC TEST RATE FORM <br />