HomeMy WebLinkAboutSoil Testing Results - 114 MARIAN DRIVE 5/12/2003 r ¢i
Town of North Andover, Massachusetts Form No. 1
c44'RTw BOARD OF HEALTH
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APPLICATION FOR SITE TESTING/INSPECTION
SSACHUSE
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Applicant .� ,, F
NAME ADDRESS TELEPHONE
Site Location '
Engineer
NAME ADDRESS TELEPHONE
Testd/Inspection Date and Time
°CIfAIRMAN,BOARD OF HEALTH
Fee Test No. '
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S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
Mau 06u.03.n 02: 27p MOR°T' 9h1DOV ER 970GOO`542 � P. d
BOARD EAL,T
NORTH ANDO V'ER9 MASS. 01845 �Z � c r- e_5
978.688-9540
AP LICATION FOR SOIL TES'T'S
DATE: d 0�� MAP&JPARCEL: i -z I
LOCATION OF SOIL TESTS:
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OWNER: V�v1lJ t TEL,NO.: tlJt�t�� p
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ADDRESS: 2
ENGINEER- v°r. TEL.NO.:
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CERTTFIE
D SOIL EVALUATOR:
Intended use of land: Residential Subdivision S 1e Family Home Commercial ``„ 11
is This:
Repair testing � Undeveloped lot testing
In the Lake Cochichewick Watershed?. Yes NOU
s•
THE FOLLOWING MUST BE INCLUDED WITO THIS FORM: r
Proof of land ownership(Tax bill,deed,or letter from owner permitting tests)
2. Plot plan
3. Fee of 1 ..(�per lot for ne&construction. This covers the minimum two deep holes and two percolation tests/
required for each disposal area. Fee of per lot for repairs or nkrrades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections. ✓
2. Only Mass.Registered Sanitarians and Professional Engineers can design septic plans,
3. At least two deep holes and two percolation tests are required for each septic system disposal area.✓
4. Repairs require at least two deep holes and at least one percolation test;at the discretion of the BOH representative, L'.
,. Full payment will,be required for all additional tests within two weeks of testing. t./
6. Within 45 days 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).
7. Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Wait Bel This Line
N.A.Conservation Commission Approval:
Date Received: _ G Check
�/" � Amount:. ��1�. ae Check Date: .. ��
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BOARD OF HEALTH
NORTH ANDOVER MASS. 01845
978-688-9540
APP LICA11ON FOR SOIL, TESTS DATE:
MAP&PARCEL:
LOCATION OF SOIL TESTS: Ld AW��1(l)
OWNER: T C'j(c.""r""+n TEL.NO.:
ADDRESS: ST
ENGINEER: l._1 6) lUL i<i r l TEL.NO.: ..1�i ,� .....
CERTIFIED SOIL EVALUATOR:
Intended use of land: Residential Subdivision"' Single Family Home Commercial
Is 'Phis:
Repair testing ,, Undeveloped lot testing Upgrade for addition
In the Lake Cochichewick Watershed? Yes No w"
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1. Proof of land ownership(Tax bill,deed,or letter from owner permitting tests)
2. Plot plan
3. Fee of$425.0 0 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
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
3. At least two deep holes and two percolation tests are required for each septic system disposal area.
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 I"-100')shall be submitted to the Board of Health showing the
location of all tests(including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Nat Write Below This Line
N.A. Conservation Commission Approval:
Date Received: Check Amount: Check Date:
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