HomeMy WebLinkAboutApplication - 1440 SALEM STREET 8/4/2009 TOWN OF NORTH ANDOVER 01 HoerH
Office of COMMUNITY DEVELOPMENT AND SERVICES �3? 0p
HEALTH DEPARTMENT K
1600 OSGOOD STREET; BUILDING 20; SUITE 2-36
NORTH ANDOVER, MASSACHUSETTS 01845 S °
E'VED
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Susan Y.Sawyer,REHS,RS 978.688.9540-Phone
Public Health Director 978.688.8476-FAX AUG ® 4 2009
healthde t townofnorthan over.com
www.townofnorthandover. ofWN OF NORTH ANDOVER
APPLICATION FO SOIL TESTS HEALTH DEPARTMENT'
DATE: �' Q MAP &PARCEL: Z064 — Z,,
LOCATION OF SOIL TESTS:
OWNER: -t a%I Contact#: q 7,g " 4G.g -3-,qZ e
APPLICANT: /J�/7,1 12,Z j �j�yl Contact#: 61-)
ADDRESS:
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ENGINEER:f'11j,�,,,K A ckA ts Contact#:
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CERTIFIED SOIL EVALUATOR: 5?4'Mk plc ISIS PC
Intended Use of Land: Residential Subdivision Single Family Home Commercial
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Is This: Repair Testing: Undeveloped Lot Testing: Upgrade for Addition:
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 nit 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 A roval Date:
Signature of Conservation Agent:, z"_ A t t I�
Date back to Health Department: (stp in): �� n
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IC 10-1
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FORM U - LOT RELEASE FORM 0
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
*****************************APPLICANT FILLS OUT THIS SECTION***********************
1 APPLICANT PHONE`7 7x k--Z-73
LOCATION: Assessor's Map Number PARCEL
SUBDIVISION LOT (S)
STREET 1 � (�'�''!� 1( ST. NUMBER
*****************************************OFFICIAL USE ONLY
E OWE D N OF TO GENTS:
,CONSERVATION ADMINIS OR DATE APPROVED
` I/ DATE REJECTED
COMMENTS_,
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FO D INS ECTOR-HEALTH DATE APPROVED
DATE REJECTED
SEPT INSPECTOR=HEAL H DATE APPROVED
DATE REJECTED
COMMENT � :� � (� �.�✓LSE!—t�
PUBLIC WORKS -SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
North Andover MIMAP 1440 Salem Street August 6, 2009
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106.A-0152 106.A-0019
106.A-0150
106.A-0132 106,A-0024
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106.A-0031
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106.A-0089 106.A-0023
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Rall Line
nerstales
Interstate Horizontal Datum:MA Stasplans Coordinate System,Datum NAD83,
Major Roads Me am Data Sources:The data for this map was produced by Merrimack
Roads %40Rrlq Valley Planning Commisslon(MVPC)using data provided by the Town of
"'Ito North Andover.Additional data provided by the Executive Office of
Easements Environmental Affalm/MassGIS.The Information depicted on this map Is
Trails for planning purposes only.It may not be adequate for legal boundary
0 detniflon or regulatory Interpretation.THE TOWN OF NORTH ANDOVER
Streams I MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
MVPC Boundary 4t 4 THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
,Municipal Boundary n P OF THESE DATA,THE TOWN OF NORTH ANDOVER DOES NOT
❑parcels —N" 41 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
THIS INFORMATION
Hydrographlo Features SSAC U
Wetlands
Exempt Lands 1"=116 ft
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