HomeMy WebLinkAboutApplication - 85 GRANVILLE LANE 7/27/2009 JUL-27-2009 03;30 PM NORSE, ENVIRONMENTAL 9786497582 P. 2
TOWN OF NORTH ANDOVER
Office of COMMUNITV DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 05G(�)AD STREET;BUILDING 20;5IJITE 2,36 s +
NORTH ANDOVER-MASSAC'HUSR'ITS 01845
�(�L 2 7 2009
Swan Y.SRwyer,KEHS.RS 978.688,9544 -Phone
Pubic Haiti Director 975.618.6476 -FAX TOWN OF NORTH ANDOVER
htu t»wnnfnrIrlbAcr HEALTH DEPARTMENT
www.lowno*amhtndover.com
APPLICATION FOR SOIL TESTS
DATI.?_ MAr&PARC LL: /l1�__Q�_ �"•�G
LOCATION OF SOIL TOTS: t�.�
OWNER: �,�,s kirw-1r7
ANl'E.IL'AN'1` �rro
���r e
ADDR1?ys: 73 Cf�i Gr l�/�V� A.
ENUINL-1 t: jr.4t,v,061vw i` 0onS&1Aor1A Ountrut a._ `7��-71'G aV
CLR PITIED SOIL ENAIMATOIL_Sf evelrl f"r;LaJ3 SC g5 _
Intended List of hand, Rosids mial Subdivision !;!ogle F'umlt�y kioma Conuneraial
Is Thb: Qepalr Testing: Vadovehrpe!Lot Teating:�, OpQrade firr Addition:
In thu!.aka Coehiobewiuk Wawrshed'i VGA Nu r
THE FOLLOWIN(;MUST RR INCLU Rp WITH THIS FORM
Y Proof of land ownerabip('11Ax 0111,or letter(hom owner pormlttlog,too&)
)r & 'X it' del dJW&I.tbrdi=9CbX e'6"f;(Adf .�jT�(.n`11��n d4ealaal
Mee of per lot lbrMeaattruetlon. 71tis o0vdtythe minimum twodctep holes And
two pewlotion tests requirad for each disposal area. [fee orJUM per Iot ror rteairs qr uoersdes,
GENERAL INFORMATION
only Conitied Solt Evaiuthns may perlbrm deep hole Inspections.
D Only Mass.x%ime red Senitarlans and Prothosloeel Lnplthom can desiSn sVtle pltnr&.
Y- At least two deep holes and two pereolatiort leant ere required ror eturh septic system dlspuaui area.
Sr Repaim require at last,mm deep hales unrl at least one pevt olutitm last,at tho disarrtlon ot•thc 1101.1
neprese nlative.
Pull payment will bo rtquimil lhr all additional WA within two wookrt nl'toting.
➢ Within 45 dayxortasting,u stwlad plan(no ttmullurthin I%)MI)shall be submitted to the hosed()t Health
showing,the location of all tats(including aborted tests),
Y WRhln 40 days of testing soli evolaatioa[brain Mall Ile submitted.
Pleas 401 WNte Bdew This Line
NA.C:oN9~116A Cvftvw ktr Apprwol Dare: 1 v`
SW NUINM orCevtmrPVr&er+ .�_
/fait back to Ileallh D"rfnrmnlr(sftmp ItO,,
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JUL-27-2009 03;30 PM NORSE, ENVIRONMENTAL 9786497582 P. I
NORSE ENvIR0NMFNTAL SERyICHS INC
92 MIDDLESEX RD UNIT 4
TYNGSBORO , M -k 01879
PHONE .- 978 - 649 - 9932 FAQ.. : 978 - 649 - 7382
FACSIMILE TRANSMITTAL SHEET
TO: FRWL
COMPANY: DATSi
Fri NUMBP-R2 TOTAL NO. OF P ACr7S LNC UDTNTG C07—al.
9 7 C& (o Sri�b L+
P-RODE NFUMBER. SENDER'S REFSPSENCE NU GF-m.
F.• YOUR KQ—r~zZNC_NUMBER:
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URGE-117 FOR R.5 VIEW a L=ASE CO\ni NT ❑ PLZA.SZ R2PLY ❑ FLT ASE R3CYCF
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