HomeMy WebLinkAboutSoil Testing Results - 146 DEER MEADOW ROAD 12/23/2014 tl
Office o " MMUN Y D V P'' NT AN f SERVI(T
HEAL-r" DEPARTMENT
1600 OSGOOD SI11 61f T; N 111 ^"<'2035
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APPLItCATION FOR SOIL T"STS
DATE:— ..�. .�.� " t MAP&PARCEL: y
LOCATION OF SOIL TESTS:h�� If 1 I'✓ l 6 '�) �G�
OWNER:_ ✓ � � — —Contact#:
APPLICANT: Contact#:
ADDRESS:
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ENGINEER: . l -,f 1 V�<. Contact
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision Smle Family He Commercial
Is This: Repair•Testing: � Undeveloped Lot��Ingg:-- 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 Testing(please indicate test pit sites on the plan)
3�, 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 clays 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
N.A. Conservation Commission Approval Date:, 6
Signature o rr atior Conse Agent
, 1 K✓, M, t
Date leach to Health Department: (stamp in): "
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