HomeMy WebLinkAboutSoil Testing Results - 227 GRANVILLE LANE 6/18/2003 Town of North Andover, Massachusetts Form No. 1
NORTFj q BOARD OF HEALTH
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7WPPP`y.�5* APPLICATION FOR SITE TESTING/INSPECTION
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Applicant. TELEPHONE
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Site Location
Engineer NAME ADDRESS TELEPHONE
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Test/I nspection Date and Ti e
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CHAIRMAN,BOARD OF HEALTH
Fee Test No.
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S.S. Permit No. D.W.C. No. C.C. Date Plbg: Permit No.
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NORTH ANDOVE,R9 MA 01845
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PL,ICA'I'ION FOR SOIL TESTS 1
DATE; MAP &PARCEL: G G / r
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LOCATION OF SOIL TESTS:
OWNER: 1-lG C , -�{ i TEL. NO,:
ADDRESS: Z1 �Oy I -A0
ENGINEER: y l #---I A C- TEL, NO.:
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CERTIFIED SOIL EVALUATOR; 01 LL-
Intended Use of Land: Residential Subdivision F Cingle Y Commercial
Is This:
Repair Testing: -'` Undeveloped lot testin :
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In the Lake Cochichewick Watershed? yes No
THE FOLLOWING MUST BE INCI.,UDEb WITH THIS FORM
1. Proof of land ownership (Tax bill, or letter from owner permitting test)
2. Plot plan & Location of Testing
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$200.00 per lot for repairs or
upgrades. (If time is not critical, fee for repairs is $75.00)
GENERAL, INFORMATION
1. Only Certified Sail Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and professional Engineers can design septic pl
3. At least two deep holes and two percolation tests are required far each septic system disposal area.ans.
4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the
BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing,
6. Within 45 days of testing, a scaled plan(no smaller than 1"-100') shall be submitted to the Board
of Health showing the location of all tests (including aborted tests).
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7. Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line 2 4,, ;xf
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N.A. Conservation Commission Approval:
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Date Received: �` ,t Check Amount: � � Check D
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