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Nebraska nsite 'wastewater 'Treatment System {
Soil Percolation 'Test Data Sheet
OwnerName 6, Y Phone
Address �•SI S o � �� ..
City State Zip
Location (Attach a sketch of the property showing test hole locations)
� l l ash l � �
%, %4 Section. ..Township Range County
Lot # Subdivision �ty
44
So- it Type (Cheek one)`
Sand Sift Clay Sandy Clay Loamy Sand Silty Clay t--
Silty Clay Loam Sandy Loam Sift Loam
Dates of Test WeatherConditions
Start Date
a al ) to End Date �' Z 1 - J L A , 20 Precipitation Avg. Temp O F
Percolation TesttLiea rements and Data
Pre- saturation Period Percolation Readings Oastperlod) Results
Start End Star! End
Water r a h
Date Ttme Date Time Date Time Water Time Level �-
Hole G
Hole Depth (MO,/ (Hr,/ (Mo./ (Hr./ (Mo./ (Hr./ Level (Hr./ Drop a o � u
No, (in,) Da Min Da Min Da Min inch Min inch d
l A :3 titi x;1 to I� /S 3 >� 3� 3,av jo,av j
3d k a lal 9 :� �'zl 1; v4 Z %�
Tests must be performed by a certified professional, a professional
engineer or a reg' to d env'ro ntal heap specialist, Sum of Percolation Rates
Signature Avg, of Percolation Rates*
(sum of rates +number of tests)
Certifiate or Liccenso# _ 1 � 6 ' `1" f (minutes per inch)
1
Address V �' Z. L4 6 4 u '
p * If rates vary by more than 20 minlin., do not
City �� W st, zi p 6 average, Use slowest rate measured for sizing soil
absorption area.
Phone tf4
Version 8-2012
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