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160 Perc Application & Test 2020a City of Northampton Board of Health 212 Main Street Northampton, MA 01060 413-587-1214 A-rl-W 6 Ax e�l Fee Collected: Pere Test Date: 6'OP 11EC)o � APPLICATION MUST BE SUBMITTED 10 BUSINESS DAYS PRIOR TCD THE SCHEDULIN , G OFA PERCTESIT, Application for Percolation ("Pere") Test Date of A pp I Home Owner Naiiie:—A2iqgg:,L/-- i 'lddi.4b -ess"- City/'town/State/Zip Code: A109,WAy"-e1)ku lvw-:55 A,14 6e-) crr�'oa�T�oxx iPT CTIECK LIST El New Construction >< Repair/Upgrade ***Number of Lots to be Pere Tested -New Construction only- Give Lot Numbers"* 4916 /N Dig Safe Sign -Off: Gas/Electrical do'l 0 d Trench Permit/Info Sign Off from DPW,(413) 5$7 457 , ------------------ ------------- - ------ - ----- -------------------------- ---------------- --------------- F ,I I..1d awma, u,, otti,o V it oit ... u, MAIL it It V, A, i it �1;� 1 it 141IML, lul27"i'M ,IIit it1„I , ;I!). if .. .. ... ....... 14 4/ 1 it crr�'oa�T�oxx iPT CTIECK LIST El New Construction >< Repair/Upgrade ***Number of Lots to be Pere Tested -New Construction only- Give Lot Numbers"* 4916 /N Dig Safe Sign -Off: Gas/Electrical do'l 0 d Trench Permit/Info Sign Off from DPW,(413) 5$7 457 , ------------------ ------------- - ------ - ----- -------------------------- ---------------- --------------- F ,I I..1d awma, u,, otti,o Property Address: _k, Owner's Name: R6 Date: 11 Performed by: Witnessed by: _2 No. of Bedrooms: st Garbage Grinder? _ Fee Paid? j( Yes CITY of NORTHAMPTON PUBLIC HEALTH DEPARTMENT Public Health Director... Merridith O'Leary Municipal Building — 212 Main Street — Northampton, MA 01060 Phone (413)587-1215 —Fax (413)587-1221 http: //www, nort.han7ptonma. gov/245/Health Pere Test/Soil Evaluation Form M of property, of deep holes/perc(s) Pere Hole# 1 .�..w <•�p.t.. •(k'v 2 $,« tPkY Ue 3 4 Elev: Elev: Elev: Start pre-soak c6; �ZI g, Sz( End pre-soak } er " dim}@1 1. }ir }'�r+, �~tis+t rtt 7f ti �p� it ((t{ < auk 'triir.. t 'a tjz A7{:� �i ,�Ii r� f pir (a t{{ q } i�i'R ,� k qkf, �, it j 4 M j � G}I'�l+r} �`+t"n' rl, �G �', '}i� {P� }k + 41x�i„a"t::: , 5t��.' 9�IS� tl ,�' lS .�. iHz} NY 41 ;?if , L} I}'.,; �}i � i�ri �i}l97j'!tt.� � 3r +�"fJ ���d �+1<.4d ix, r£,i s{si h tik i"ra} '�i�}i"}Ijj ilV++imel ii +y: }ti,a �hj F' i47 Iik;i; }}{tY i'7LE; fik t�� �t{j. lr}}j, ik{{(ppp. gg,y,{it �i)+� }{r{E Y� »u Hew t14UI+f�i (+ttk "a}, xil } til 7...Y1 Et,#i# i{sl� i�?`.:���>+��,�l3II11;:GH Time @ 6" } 'h1 dr "*.^'" ,'r" h T,{, `i” tiE';a � _ fl 'ktt �""'A r�.�5 #. �' ""i,V"e ��„� ��°"R,. '�i '" ».u��, i5 � �+gami ,r�rr� i �i 3— ;! T $� E1 psedtim N,, .Ai .+� 1 nr ,.ii_ L i4r. _� pp;SnmWryrynTMy }i „it...!ik. wh. tt �k,rr . s y x f} r�' �L ,�.. Pi t {} k! . 1, ,„,,. 9"-6" Rate (min/in) -1� d IP► �9— Deep Bole Observation Log Depth From Soil Horizon Soil Texture Soil Color Mottling Surface (inches) (inches) a14 aq-UG Ii©... (7 10 WO O `-y a rn04tUfQ fi'R I'd M.�}'�ii���3,.��%�:�+ '�'i94nu �ikk'4' �' �'}� !�i"a �'� "zj�3Ny.m�. ,mANpi a 'p i ` �£;g" J (� k c RNA, � IRIRLa "� tial ►� V " l % u l�n i.. `� `�Ff�ry �: '" i� i' M i F!t!ij�{ Inti 4t � //y�VZO { p I 9 hi y i �o kn�} ' 'e; .� X11 YR' 1rfiro }4fy iEatiliu� `tri i� h`d ekd} i�. �if# irk#`* it 1111," �'�U�ifi''w,k RiP`�i�� Sf{6111, 4 i��f`ff�Nj'}}ii{Jtt?ia 't L a }4y.11 n�x0 nhu. tl 'Yi S 1-31 #ice y m U 'A, -.1, Pr ..?l... , t!'L Yt, -LIr