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(� :E o m -� 3 m a ° o _ j C) �. 0 0 CA CL o CD � p O X CA CD cn o � O a U) 1 w_ cn CD CD (D O Q O a mQo m Q N X CD Q NC "O C U 0 CD cn cfl tQ 7 0 (D - T 0 = J 0 CD w 0 n m n n 3 o 0 CD � �o (n 3 0 m Q cn � O (n (CD A) v' C ® CO) r•F (p D N CD B rl' O o t c cn �• o rF C0 w U) 6 m (A `� (D N 3 CD CD CAO ' (A (D N O 9 (D 0 N .D O O N N (D 00 0_ ;Commonwealth of Massachusetts City/Town of North Andover W Percolation Test Form 12 c, GSM 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. Important:When filling out forms A. Site Information on the computer, use only the tab Mark Rae key to move your Owner Name cursor-do not 600 Foster St. use the return Street Address or Lot# key. North Andover MA 01845 ree City/Town State Zip Code 508-509-9430 Contact Person(if different from Owner) Telephone Number ems° B. Test Results 8/2/11 10:41 Date Time Date Time Observation Hole# P-1-11 Depth of Perc 44"718" Start Pre-Soak 10:41 End Pre-Soak 10:56 Time at 12" 10:56 Time at 9" 11:08 Time at 6" 11:24 Time (9"-6") 16 min. Rate (Min./Inch) 6 min/in. Test Passed: ® Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ John Barrows Test Performed By: Issac Rowe Mill River(for North Andover BOH) Witnessed By: Comments: t5form12.doc•06/03 Perc Test•Page 1 of 1