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�oF4U41 <br />'I. <br />ENVIRON <br />18fi8 MENTAL HEALTH DEP <br />\4/i?or,;S TelephQne_ � East Hazelton Avenue, DEPART <br />(�09) 468-3420 Fax: (209) 464-01138 on' CA 95205-6232 <br />PERCOLATION <br />www sl90v.org/ehd <br />ADDRESS OR LOCATION: 25-I 30 OLATION TEST RATE <br />OWNER NAME: ISI. P [� ' p A <br />AEN: vct _ V D�. _ �`� o <br />Z 50 CITY: A ca lm o <br />SOIL TYPE: G k APPLICATION #: s200 501 DATE: 3 /Z -Lt 2 <br />REMARKS: S <br />DEPTH TO FIRST WATER: _-Ft <br />PERCOLATION TMT S.ETCR <br />S2' Dlsme4T PVC Pip* <br />1.98 <br />+ <br />2 . I�7 <br />ReNll Lmh _q- 1 J— Li 3 r <br />TION OF <br />W,71_ <br />P"MATION TW 51OTCR:• Dmw„ PVC ft,L1.43 <br />,Vol <br />0.17' WaW <br />Test Hole # 1 Test Hole # 2 <br />Parcel: Diameter: in I Depth: Z.1 Parcel: Diameter: in I Depth <br />TIME <br />READING <br />WATER DROP <br />REFILLED <br />c1:00 <br />pf <br />q:36 <br />PV1 V <br />10:00 <br />. 3 <br />`i•0 <br />lo: 30 <br />4.56 <br />. L('; <br />1( I <br />t1:00 <br />.Fq <br />,Kr <br />•r <br />rr:3o <br />.sZ <br />.36 <br />ro <br />rZ:Oa <br />35 <br />q-17- <br />•1212-30 <br />12-:10 <br />Lj •`dr. <br />.3 <br />. l <br />f:00 <br />L4 . q7 <br />PERCOLATION RATE: a 3 min/in <br />RECOMMENDED SEPTIC ARr;A: <br />TEST PERFORMED BY: <br />TEST CERTIFIED BY: L <br />OBSERVED BY (RENS): <br />EHD 42-03 REV 11/2/09 <br />TIME READING WATER DROP REFILLED <br />minlin <br />PERCOLATION RATE: ...... <br />RECOMMEN ED SEPTIC AREA: <br />Phone: 3l�a"0Date73 <br />Phone: <br />Date <br />Phone R30Date <br />PERC WTEST RATE FORM <br />