308 Perc 2011 •
Commonwealth of Massachusetts
- - City/Town of Pittsfield
�_ • Percolation Test
Vi_i - ° Form 12
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used,but
the information must be substantially the same as That provided here. Before using this form,check with
the local Board of Health to determine the form they use.
ImPan,nt: A. Site Information
when o
forms ann the iha Patrick Melnik -- -
computer.use — - -
onlythe lab key Amer Name
to move your 308 Chesterfield Road
cursor.do not Street Address or Lel e
use the return MA 01060
key. Northampton
Citylfown _.. (State
413 Zip Code
4 O Eric Melte — _ (413)582-7000
Contact Person(II different horn Owner) Telephone Number
0m° XD B. Test Results
111212011 1:58 11/21/2011 2:39
Dale Time Dale Time
PT3 PT
Observation Hole it - -
35" 36"
Depth of Perc
1:58 2:39_
Start Pre-Soak
End Pre-Soak2:11 2:52
2:11 2:52
Time at 12" -
Tlmeat9" 2:26 3:10
2:37 3:40
Time at 6"
15 30 ..
Time(9'-6')
5 minlin 10 min/in _
Rate(Min./Inch) ""-
Test Passed: ® Test Passed:
S� win_ Test/F Test Failed: 0
Eric Melte, PE
Test Performed By:f Y
Ed Smith, Norhmapton ROH
Witnessed By:
Comments:
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