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4 Perc Test 2009 BOARD OF HEALTH MEMBERS JAY FLEITMAN,M.D.,Chair SUZANNE SMITH,M.D. DONNA C.SALLOOM XANTHI SCRIMGEOUR,MHEd,CHES DIRECTOR (413)587-1214 FAX(413)587-1221 To: Marc Durso Berkshire Design Group 4 Allen Place Northampton, MA 01060 /CITY OF NORTHAMPTON MASSACHUSETTS 01060 OFFICE OF THE BOARD OF HEALTH PERCOLATION TEST FEES RECEIPT 212 MAIN STREET NORTHAMPTON,MA 01060 Date: June 19, 2009 Pere Test requested by The Northampton Board of Health charges a fee for the witnessing of percolation tests: $50.00/hr - (minimum fee-$50.00). No. Date 1. 5-20-09 2. 3. Location Lot# Kensington Estates Ellen Bokina Witnessed by Ellen Bokina Start Time 1. 8:30 am 2. 3. Stop Time 4:30 am Hours 7.50 Total Hours: 3.0 @$50.00/Hr. Re air Amount PAID: $375 .00 CK#8380 dated 6-12-09 Please make checks payable to: The City of Northampton and mail to the Board of Health Office,212 Main St., Northampton,MA 01060 Thank you. Ellen Bokina, Title 5 Inspector