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AUUFiE55 UH LUUAI IUN: I v I f HI-'IN: 1 41 O - O I <br /> )WNER: �k c DATE: <br /> APPLICATION #: DEPTH TO FIRST WATER: 0 P N r_- ft SOIL TYPE: <br /> 0 <br /> ,3EMARKS: <br /> z�7"• <br /> LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) <br /> �1.1 141 <br /> SOIL PROFILE (IF REQUIRED) Qe-vim Lv,2"a <br /> Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type Depth Soil Type <br /> TEST HOLE #1 DIAMETER: `i in DEPTH: H I In TEST HOLE #2 DIAMETER: In DEPTH: In <br /> TIME READING WATER DROP REFFILLED TIME READING WATER DROP REFFILLED <br /> D"i 'E! ,So (a.2Li <br /> 5, QPM <br /> lc)=3u �J.sLe Zo <br /> 12 :0 U.Ljq , ZZ falls - <br /> 12:3� �•3� 2�1 �v.�� <br /> I .oma ire 3 .-Zia <br /> PERCOLATION RATE: 3 min/in PERCOLATION RATE: min/in <br /> RECOMMENDED SEPTIC AREA: RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: (�" Phone:(Z O 11) -74-7 -520 Date: 9/7ZJ <br /> TEST CERIFIED BY: Phone: �E� �/ Date: <br /> OBSERVED BY(RENS): Phone: �6� '��{ Date: — 5, <br /> EHD 42-02-003 PERC TEST RATE FORMic <br /> REVISED 5/7/02 " / 1��. I 1-63 <br />