HomeMy WebLinkAboutSoil Testing Results - 296 RALEIGH TAVERN LANE 10/27/2014 a'
TOWN 01; NORTH ANDOVER
Office ce t'w1"t ,"Ol Sal U1 S ry DE "E1,011M N'T A N D FAM ::'E'S'
E M;r" DEPAIITMENT
1600 t SGOOD s,°1°R E, T; SIJ1"11K 2035
N0R.TJ I AN DO VFA, MASSAC1 IC_1SI1 I""I'S 0 184 5
Susan Yn Sawyer, R!"l15,It.S 978,688.9540 Pho twe
Public:Health Director 978 68 8476 FAX
.
Ire.«t,ltdrtlt t7t(cr,to-%vrrgrdttt?r tli,,ttd(,i,o...r._C<xt
1E D
vw�vwtr l rrsvrrrrfitr.rw•4lrwttrtlr�veuor,trbt,.
APPLICATION FOR SOIL TESTS OGI Z9 2014
TO1 P4'w;aw NOR-wi AIZOVER
I°°1EAL.""fH DEPAI"ITIM 11T
DATE: 1(7—` 4- I MAP&PARCEL:_ C?&
LOCATION OF SOIL TESTS:-��I � I�r� � I � I-A)A
OWNER: 1.1 At- Contact#:Av) -� � -
APPLICANT: 1✓ Contact#:
ADDRESS:
ENGINEER:Mjtjq, Arjf/ �'1,,J (L, �Y�,'{ �
Contact#:
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision mgle Fan y Home Commercial
Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition:
In the Lake Cochichewick Watershed? Yes No ✓
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
Proof of land ownership(Tax bill,or letter from owner permitting test)
8.5"x 11"Plot plan&Location of Testinsz(please indicate test pat sites on the plan)
1 Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of$360.00 per lot for repairs or upgrades.
GENERAL INFORMATION
➢ Only Certified Soil Evaluators may perform deep hole inspections.
➢ Only Mass.Registered Sanitarians and Professional Engineers can design septic plans.
➢ At least two deep holes and two percolation tests are required for each septic:system disposal,`area.
Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOH
representative.
Full payment will be required for all additional tests within two weeks of testing.
Within 45 days of testing,a scaled plan(no smaller than I"-100')shall be submitted to the Board of Health
showing the location of all tests(including aborted tests).
➢ Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
..... „�, 6�0 �,,,,_ m ...,.,, ."......
,.,
N.A. Conservation Commission Approval Date:
t
Signature of Conservation Agent. , ,.�� t"I�. ������� � ._.��I D
°mm
Dale flack to Health Department: (stamp in): �
-------------
-4 y iAy'
------------------
r
1 Vol
r x or
r
�w
t �' w
t
,.. ' /,,,.r
b' 6"or w
r � o
1 r ra
j � r
o
� Un
_.
off 44
W �
i1) _ �
1
r
/i
/f