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254 Perc Lot 5 2019 • CITY of NORTHAMPTON Lot � PUBLIC HEALTH DEPARTMENT 1 Public Health Director—Merridith O'Leary P Municipal Building-212 Main Street-Northampton, AIL4 01060 Phone (413)587-1215-Fax(413)587-1221 http://www.northamptonma.gov/245/Health Pennrc Test/Soil Evaluation Form Property Address: 7ti}�� I [iD h PY, Lrot S Owner's Name: (fit l ffff 't"0-6 Date: Performed by: �' OL611 W t�S S; 5 c�I,c f S Witnessed by: .q '# I 1 f No. of Bedrooms: �q� �D h- fi10r re Q � Y L y < ! F Garbage Grinder? Yes No . `` Fee Paid?I/Yes �No :$ Sketch`of property,and location of deep holes/perc(s) fr i S =='a i �• £ v rr Percolation Test 77 Perc Hole# 1 2 ''` 3 4 Elev: �� ` Elev: Elev: Elev: Start pre-soak End pre-soak r y _. 'Tim@ 1 a j I ...r, ..z..:��>�.:�� •..¢ ? ''`�. r. t �,-x,Ra ..., �� <' �'ta x w-., i^. �.,1:. 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