HomeMy WebLinkAboutSoil Testing Results - 45 HOLLOW TREE LANE 11/1/2001 Town of North Andover. Massachusetts
1 "°RT" BOARD OF HEALTH Form No. 1
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RADRATED WPPp\\"�5 APPLICATION FOR SITE TESTING/INSPECTION
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Applicant 16zjlj
NAME 74
/ I ADDRESS
Site Location TELEPHONE
Engineer � //
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NAME [�
ADDRESS
Test/Inspection Date and Time �1/ TELEPHONE
Fee CHAIRMAN, BOARD OJ HEALTH
Test No, d 6 -;5 0
S.S. Permit NO..D.W.C. NO.
---___C.G Date�_plbg, permit No.
BOARD OF HEALTH
NORTH ANDOVER, A 01845 � V ok'.
978-688-9540 off', +lvv
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APPLICATION FOR SOIL TESTS MOP
DATE: -!�l= p MAP &PARCEL:
LOCATION OF SOIL TESTS: j-i01-j'1y
OWNER: P?�rg l i`k i-J Qb
ADDRESS: y�
ENGINEER: 'c c-d (" I��-�� —TEL. NO,:
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision Sin �mul~'y tl6me Commercial
Is This:
Repair Testing: _ Undeveloped lot testing:
In the Lake Cochichewick Watershed? Yes No 1;11 �,
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
I. 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
I. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarian 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 Not Write Below This Line
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N.A. Conservation Coninission A royal: ,c.�,�„�,�J�
Date Received: ( 01b”e.�`'/ Check Amount: `� �'C Check Date: %,' � r
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