HomeMy WebLinkAboutSoil Testing Results - 130 MARIAN DRIVE 3/15/2012 ANDOVER'
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TOWN O�' �bII�T� �II11
118 ll1E S'YL. .d '11. IP.A".IILA P. RyII.V1.P35.ENT HIM
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1600 OSC OD STREET;I, BUILDING 109 SIII ICT' L,,.6 � ti ��43
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Sus,m V.Sawyer, 11EII r, lih 418.688.9540 Phone
Public Heatltll Birector � '10 � q 978,688.8476 F"i1 N
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APPLICATION FOR SOW TIEST
DATE: MAP&PARCEL:
LOCATION OF SOIL TESTS: "fit'° "A o�,��®�_ � �
OWNER:— J U �, K)) A Contact#: 4
APPLICANT:__ Contact#:
ADDRESS: l G o -- "
ENGINEER l l� �i /� 'Contact#: (-T70)
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CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Reside tr'a Subdivision Single Family Home Commercial
Is This: Repair Testing:1 Undeveloped Lot Testingo Upgrade for Addition:
In the Lake Cochichewick Watershed? Yes No
TIRE FOLLOWING MUST BE INCLUDED WITH THIS FORM
Proof of land ownership(Tax bill,or letter from owner permitting test)
x]],,plot plan c&Locatiara of Testfit n(please indicate test pit sites on the Man)
> 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.
A. Conservation Commission Approval Date:
Signature of Conservation Agent: CIL-
Date back to Health Department: (stamp in):
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