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174 Site Review 2000 PERCOLATION TEST(S) Time: Time: Observation Hole #1 Observation Hole #2 Depth of Perc Depth of Perc Start Pre-soak Start Pre-soak End Pre-soak End Pre-soak Time at rl Time at 12" 9" fi Time at 9" Time at 9" • Time at 6" Time at 6° Time (9"—6") - Time(9'-6 ) Rate Min/Inch Rate Min/Inch 'minimum of I percolation test must be performed in both the primary area AND reserve area. • Performed by IMEM performed b Witnessed by Witnessed by Comments_ ion Address or Lot# NORTHAMPTON BOARD of HEALTH- Title 5 - Site Review leer Land Use Landform 'osNon on Landscape(sketch on the back) yen Water Body feet ssible Wet Area feet Time 17 V 4 Weather Slope Vegetation Distances Drinking Water Well Drainage Way Owner Ut-ov a4 i Surface Sto c 1 Phone# yes Start Time Stop Time feet Property Line feet Other feet feet a Hole#: opt from ice(Indies) Soil Horizon DEEP OBSERVATION HOLE LOG' 'MINIMUM OF TWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Other Soil (Sbucture,Sto nes,Bauder%Consistency %Gravel) Soil Texture (USDA) Soil CoV (Munse I) 'anent Mabal(peobglc) I Depth to groundwater Sandrg Water in the Hole Estimated Seasonal High Ground Water Depth to Bed wasp m M10 7 Igo Pn Face I /� fep Hole#: Depth from udace(Inches) I( Soil Horizon DEEP OBSERVATION HOLE LOG' 'MINIMUM OF IWO HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA lolI Color Soil (Munsell) MOWi Soil Texture (USDA) Other (SWcture,Sto nes.Boulders,Consuteiwy,%Gravel) Parent Maviai(geologic) I Depth to groundwater. Standing Water in the Hole Estimated Seasonal High Ground Wate r Depth to Bed Weepi fro m Pit Face