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A09!.1ySAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> - •' Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: b CITY: <br /> OWNER NAME: / DATE: <br /> APN: �v7 �� ®6 APPLICATION 9: DEPTH TO FIRST WATER: Ft <br /> SOIL TYPE <br /> REMARKS: <br /> LOCATION OF TEST HOLES SHOW WELLS AND STRUCTURES <br /> PERCOLATION TEST SKETCH _ PERCOLATION TEST SKETCH <br /> 2-LSI DIA-PVC PiPFJ - -3 2-IN DIA.PVC PIPET <br /> 4 IN DIA.Snit,BORING 4 IN DIA.SOIL BORING <br /> 310 <br /> Ug <br /> REFaA,mGHT - <br /> � i- <br /> � I <br /> SOIL PROFILE IF REQUIRED <br /> Depth Soil Ty Depth Soil Type Depth Soii Type Depth Soii Type Depth Soil T e <br /> Test Ho{e#1 Test How#2 <br /> [P�arcejDiameter: Depth: Parcel: Diameter: in De the <br /> TIM- READING WATER DROP REFILLED TIME READING WATER DRDF REFILLED <br /> C-X7 s X- r f <br /> r f <br /> O ' �° D D _ ,� O <br /> 1fa <br /> 3 . 00 <br /> /60 fo <br /> a � p <br /> O 1 e"- <br /> I � `-i r o <br /> 00 b ' <br /> ZSO miNin P COLATION min/in <br /> PERCOLATION RATE: -__— <br /> RECOMMENDED SEPTIC EA:_ <br /> _ RECOMMENDED SEPTIC AREA: _ <br /> T _ I `�- Phone: 21v �0�Z Date <br /> EST PERFORMED BY: <br /> Date <br /> TEST CERTIFIED BY: _- Phone: �.��--Utk €f <br /> Phone - Bim' Date =' ` <br /> OBSERVED BY <br /> (RENS)- -ST RATE FORM <br /> iw EHD 42-03 REV 1172709 <br />