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F'tKL;ULA I IUN I t5 I RATE <br />CITY: —�� �/" /-P `^J <br />DATE: <br />_ APPLICATION #: 000 DEPTH TO FIRST WATER: Ft <br />LMAUION <br />OF TEST HOLES <br />SHOW WELLS AND STRUCTURES <br />REFILLED <br />;3 _- <br />/./7 <br />---- <br />a- <br />— <br />0.05- <br />p. o 5- <br />- <br />0. <br />o : 3Y _ <br />%, bo <br />--- <br />-l�°b <br />Ifs <br />O <br />I <br />FlF <br />1 i <br />1 <br />I—F <br />I <br />I <br />I--1 <br />i_ <br />kF <br />—_1 <br />� <br />LT <br />- <br />F-1 <br />n-_T�II <br />__`FFF1PH <br />f--n-f <br />_ <br />1 <br />1 <br />-- <br />— <br />n <br />E <br />— - – r—� <br />n in� 1 n Inn F i i !- <br />n_--�I-. !nn--- <br />_._. nn nn n= <br />r- Hl H-1 <br />• _-- • •s-• • •: �s• • •: �-• • •- <br />TIME <br />READING <br />WATER DROP <br />REFILLED <br />;3 _- <br />/./7 <br />---- <br />a- <br />— <br />0.05- <br />p. o 5- <br />- <br />0. <br />o : 3Y _ <br />%, bo <br />--- <br />-l�°b <br />rCRIivLH I IVIY KA 1 C: _ <br />RECOMMENDED SEPTIC <br />TEST PERFORMED BY: _ <br />TEST CERTIFIED BY: <br />OBSERVED BY (RENS): <br />EHD 42-05 REV 1111109 <br />TIME <br />READING <br />WATER DROPREFILLED <br />v. Zo <br />0. <br />--- <br />-l�°b <br />Ifs <br />O <br />""""` I C. ) V min/in <br />RECOMM NDED SEPTIC/ AREA: <br />Phone: Date <br />Phone: Date <br />Phone Date _ <br />61 <br />�`�J <br />PERC TES�RATE <br />