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ooq�IN. o SAN JOAQUIN COUNTY <br /> �" ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: � <br /> `�; 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> � r Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> '9C I F O Ri, <br /> / <br /> PERCOLATION TEST RATE <br /> ADDRESS OR LOCATION: Iq 3 '�/ I Sv s�• 1�T rrde'1 t�CITY: AcaytAj2o <br /> OWNER NAME: 5r DATE: 3 HL2_ <br /> APN: O 13 ZII2Z-3 Z APPLICATION#: s�y� DEP TO FIRST WATER: Ft <br /> SOIL TYPE: ! n K" -P i,)(, ;c ZJ!j tocu, / Tw1 L ,A(A LOGLyu. 0�, <br /> REMARKS: <br /> LOCATION OF TEST HOLES (SHOW WELLS AND STRUCTURES) <br /> i <br /> ........... ........... <br /> PERCOLATION TEST SKETCHPERCOLATION TEST SKETCH <br /> 2"Diameter PVC Pipe ,—� j 2"Diameter PVC Pipe71 <br /> i 12/J <br /> .....__a....__.... g........._I_. }--1--- l/ <br /> a - <br /> 20 <br /> " <br /> .........'� 0.17'gravel .,`-.` 0.17'gravel __._.. <br /> Refill Level: (0 -� , Z ! Refill Level: `- L .. <br /> _ _ <br /> SOIL PROFILE(IF REQUIRED) <br /> Depth Soil Type Depth Soil Type Depth Soil Type Depth I Soil Type Depth Soil Type <br /> -•1.5-' <A-" s 5.S- b' 5C'd r:iI <br /> P l-3 Test Hole # 1 Pi Test Hole# 2 <br /> Parcel: I Diameter: Ci in Depth: Parcel: I Diameter: in I Depth: <br /> 71 <br /> TIME READING WATER DROP REFILLED TIME READING WATER DROP REFILLED <br /> q 0 0 �00 �- <br /> 61 T3 Z4-�64 ' 17 x-1.3 5, q <br /> ioioo q ,C'fC4 . 01 ((.33 16 00 C(, 5 5 Ci. L'5- <br /> 10 t' 3 <br /> S1at' 3 K,kZ '0q cl,3q V-30 9 ,66 1 q . `6 <br /> 11 ; r� q'Ll3 .o (4 ,3 S' c t '-bo q .65 11 <br /> 11" 30 u .u3 '05 q, 35 11 : 30 C, . 6Z I . ih' <br /> 1 '2,,ot) (4Z . D lZi0o C . 6K CT, IZ <br /> 17;30 .0 (4 - 33 1Z; 30 Q . 6L1 5 a . ls <br /> F :OLATION RATE: min/in PERCOLATION RATE: min/in <br /> RI=COMMENDED SEPTIC AR RECOMMENDED SEPTIC AREA: <br /> TEST PERFORMED BY: t,c.1.0 Phone: CZU91 36y —0345 Date 3/11 /Z1 <br /> TEST CERTIFIED BY: Phone: Zo 9 3Lh -o3-17Date 3-11 - Z 1 <br /> OBSERVED BY (RENS): Phone 200? 616 M I Date 3 f !J 2-1 <br /> EHD 42-03 REV 11/2/09 PERC TEST RATE FORM <br />