HomeMy WebLinkAboutApplication - 940 JOHNSON STREET 10/3/2011 v.f
TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
4600 OSGOOD STREET; BUILDING 20; SUITE 2-36
NORTH 1? SA,CHUSETTS 01845 S�«i�5ti
Susan Y.Sawyer,REHS,RS �� _-- f � 978.688.9540-Phone
Public health Director f} 978.688.8476-FAX
OCT - 4 ?01 1 healthdept_a ttownofnorthandover.com
C'!- 'ff'6 0 /"� www.townofnorthandover.com
`TOWN OF NORTH AN)OVER
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APPLICATION FOR SOIY:�T'E�T _—
DATE: D MAP&PARCEL:
LOCATION OF SOIL TESTS: �C (t`)�� (i`) <2T:
OWNER: e'A,nmicLA, Contact#: 6AR2 6 1��
APPLICANT: Contact#:
ADDRESS: "2--7 VL- VOO IQ _L! HA,
ENGINEER:POM t:-Wij f 06Wa6Contact#: (el 25
CERTIFIED SOIL EVALUATOR: *(.Lt-_ .taiz5l y ¢'l/ye") C�v -(rte 2-0 651 Intended Use of Land: Reside 'al Subdivision Single Family—Ho e Commercial
Is This: Repair Testing:M Undeveloped Lot Testing Upgrade for ition:F
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)
➢ 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 1"-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 Approva Date: �� l
Signature of Conservation Agent: 4�4a- 616
Date back to Health Department. (stamp in):
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