HomeMy WebLinkAboutForm 12 - Perc Test - Soil Testing Results - 531 Boston Street 10/18/2023 Commonwealth of Massachusetts
- City/Town of
Percolation Test
- 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.
Import nhen A. Site Information
filling o�t s
on the computer, M8 E. Cohen Trust
use only the tab Mary
key to move your Owner Name
cursor-do not 0 Boston Street 107.D-51
use the return Street Address or Lot#
key.
North Andover 01845
ay CitylTown State
Zip Code
Gen4 Builders, LLC
Contact Person(if different from Owner) Telephone Number
B. Test Results
10-18-23 9:50A 10-18-23 10:30A
Date Time Date Time
Observation Hole# PT 1 PT 2
Depth of Perc Shelf a@ 30", Perc a@ 48" Shelf (a_ 36", Perc (@_ 54"
Start Pre-Soak 9:55 10:33
End Pre-Soak 10:10 10:48
10:10 10:48
Time at 12"
10:49 11:35
Time at 9"
11:50 12:57
Time at 6"
61 Minutes 82 Min
Time (9"-6")
21 Min/Inch 28 Min/Inch
Rate (Min./Inch)
Test Passed: Test Passed:
Test Failed: ❑ Test Failed: ❑
Thomas Schomburg / S E#14779
Test Performed By:
Isaac Darowe
Board of Health Witness
Comments:
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