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9Psu1 5AN JOAQUIN COUNTY <br /> good: <br /> add ENVIRONMENTAL ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2 : —rrr y <br /> "id <br /> { 1868 East Hazelton Avenue , Stockton , CA 95205 -6232 <br /> got Telephone: ( 209) 468 -3420 Fax: (209 ) 464-0138 Web : www. sjgov . org/ehd <br /> a o � PERCOLATION TEST RATE <br /> ) DRESS OR LOCATION : may ) g �f S . CP� � E t2 i� CITY : 'T !�'tc y <br /> NNER NAME : 1Ii"`lilF1*J1dd" Jn/ DATE : 6ZZ-gI21 <br /> ,IN ; 2S0 � ) " Z APPLICATION #: S R 0o D 3Q 04 DEPTH TO FIRST WATER : Ft <br /> Fog <br /> SIL TYPE : GQO " OV% IIJ�✓Ll�cow a le X (t l0. 0 <br /> EMARKS : <br /> LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES ) <br /> PERCOLATION TEST SKETCH PERCOLATION TEST SKETCH _ <br /> 2" Diameter PVC Pipe 2" Diameter PVC Pipe <br /> aMotown <br /> - - Z 2 - <br /> - 2 . i3 5 . 05 <br /> 2 . 30' <br /> ORION <br /> � (� 0.77' gravel 0.17' gravel <br /> Refill Level: 9( ••' 4 ` . Refill Level: I <br /> SOIL PROFILE ( IF REQUIRED) <br /> Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type <br /> O — Z .30 S <br /> Test Hole # 1 Test Hole # 2 <br /> Parcel : t Diameter : in Depth : 2 . 30 Parcel : Diameter: in Depth : <br /> TIME READING WATER DROP REFILLED TIME READING WATER DROP REFILLED <br /> x : 00 Dr — �( . � 0 <br /> 1 : 3o sm* 04 4 6q Lie5t <br /> 9 : 00 5700(1 • K9 <br /> q : 30 40 ,14 646 � . 4a <br /> to600 C4 q i • 42 Li " � � <br /> 10 : 30 4 " g5 • 4q L1 # q q _ <br /> 11 : 00 Colt . 17 0300 oo41 <br /> 11830 4 , <br /> 12600 4 . $ 5 2 <br /> lERCOLATION RATE : $ . q5 min/ in PERCOLATION RATE : min/in <br /> tECOMMENDED SEPTIC A A : RECOMMENDED SEPTIC AREA : <br /> 'EST PERFORMED BY : Phone : C�oci ) 3661 - O3 ? 0 Date <br /> ' EST CERTIFIED BY : Phone : Zvi 3 (pl - o 3'1 f Date G - L 5 - Z I <br /> ) BSERVED BY ( REHS ) : (r7rrn1a ,2 at. Phoneb �tTL(y ,: l,;) tL Date ( . 114 / Z ( <br /> HD 42-03 REV 11 /2/09 PERC TEST RATE FORM <br />