HomeMy WebLinkAboutSoil Testing Results - 81 SAW MILL ROAD 5/5/2003 Town of .jrth Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
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APPLICATION FOR SITE TESTING/INSPECTION
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Applicant
NAME ADDRESS TELEPHONE
Site Location
Engineer
NAME ( ADDRESS TELEPHONE
Test/Inspection Date and Time � o
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CHAIRMAN, BOARD OF HEALTH
Fee =l
Test No
S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No.
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BOARD OF RE ALT H
NORTH ANDOVER, MASS- 01845 �;�, � 62003
91a.698.9940
APPLICATION F01 SOIL QT'S �-
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LOCATION OP SOIL fFSTS-- 0 r
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ADDUSS:
'ALL.NO.
CFXrlp1E.17 SOIL EvALUATOR= �Homo Comntcrcial lrmndcd use of land' Residcncial Subdivision Single
sdrrg� . ti
18 Tbls: Undeveloped lot c
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Repair testing No
In the fake Cochichcu ick-vv atcrshoV Yes
THE,V0T�L4WING MUST RE INCLUDED V ffH Tt11<S roRm' costs
1. pl-"f of land ownepship('ray,hill,dcod,or letter from owner.p
errnUttng
Plot plan
of 25, per tot for new constructiUn- 7hiseC lot fo rcminStor a p holes and two percolat�oat tests
3. Tie eal atta Fee oC$ p
required for each dispo.
GEN ,u L INV RMATION
Certifted Soil Evaluators may perform deep hole inspections. tic bans.
1, Only 4inrer,8 can design septic P'
Mass.
Registered ire f<)t each seplic sYrxcm disposal area
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2, Only e istered Sanitatians and Professional is a ,Gtior of the i3O1i representazive.
3. At least two deep holes two deep pholesa and owes are p rco attvn test,at the disc
4- Repairs req
uire at feast two deep holes and at least one pe weeks of Cesting, the
5, full payment will be 4e9ulrcrJ for all additional tests within n V two
6. within 45 days of testing.
a scaled plan(no smaller than 7"-lam')shfllE be submitCed to the ward of l:iealth SAowtnn
location of all tests(including aborted wsts).
7 Within GO days of testing soil evaluation forms shall b submitted. � �
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N.A.Conservation Cotnmis4ian ApD c�,,L
Cbak Armmnnt:
Check Date: — —�
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