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254 Perc Lot 2 2019 CITY of NORTHAMPTON PUBLIC HEALTH DEPARTMENT Public Health Director—Merridith O'Leary "v P Municipal Building—212 Main Street—Northampton, MA 01060 Phone (413)587-1215—Fax(413)587-1221 http://www.northamptonmagovl245IHealth Perc Test/ oil Evaluation Form S o o m , Property Address: g Owner's Name: Date: w Performed by: I �E Witnessed by: No. of Bedrooms: JAI) w� !C) Garbage Grinder? YesNo Y OT" Fee Paid? 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Yes Sket of property-In location of deep holes/perc(s) IC � P colation est; Perc Hole# 1 �� 2 �'` 3 4 ., Elev �� v Elev: Elev: Start pre-soak End pre-soak _ WY A 4& cprMT wins mv" nn) oloM NA R ��s I a t � a a Z s �. .: � xti° � roffiMe A UI 15,M U •_.- Time @ 6 - El ps&tirN ro L J_ 9 L L 9"-6" Rate (min/in) La L l h h yn ■4 1 ail LTE CD, $ § - , . 1 ■ � md. � . ® : } < � �� •.��}�� �` • ����� � }� \\� ' »: . �\\ �\ �\ ^ • Owner < » » , . LO \ Address