HomeMy WebLinkAboutSoil Testing Results - 53 WHITE BIRCH LANE 1/9/2006 TOWN OF NORTH ANDOVER j OORTk
Office of COMMUNITY DEVELOPMENT AND SERVI("E
HEALTH DEPARTMENT
400 OSGOOD STREET
NORTH ANDOVER, MASSACHUSETTS 01845 ry'SSACNUSE��ss
Susan 1'. Sawyer, REINS,RS 978.648.9540--Phone
Public health Director- 973.688.8476—FAX
healthdept(Lvtownofhorthandover coin
w«-w.townotnorthandover.com
APPLICATION FOR SOIL TESTS
DATE: 1 _ ;_% MAP&PARCEL: r
LOCATION OF SOIL TESTS: r
Contact#:
APPLICANT: was r. Contact#:
ADDRESS:
ENGINEER: ;i2fs'.l��ri' "� t,� r f;r:r.ri ' Contact#:
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision ' Single Family Home, Commercial
Is This: Repair Testing: I___ 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 pit 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 Approval DateCZU
n
Signature of Conservation Agent: //i�1U�' 1
Date back to Health Department: (stamp in):
lln I W O
LOT 4
A
TOP OF
FOUNDA TION
ELEV. 142.+45'
N
Lo
EXIST. 21' On
FND.
1 36�
25' LOT
TP\ 37'
G l
--- 1500 GALLON
5
SEPTIC TANK
8 TP
W
�- T' H 42' Pr 7T'' D_g0X
30.64' 15'
42'
88.7'
WHITE BIRCH LANE
IM, ' ,RIM " P
P
r r
t
R
I I q
r
o x d
A
r
_ n
i
I I
.w
1
1 v y
r
f � .
P � /
y
J
I
p
i
r
r ,
i
��p r
71/r�. ,,,i,„� r ,,,f,✓/r.///,/�,r,,,,;/�irrrnll,�a G„ic.% J�/i/1,r,/%0,,,//�r,,,,'�/i/l'/AG�rimr,%//din/1,,,//„//D/ill r/r1`l y�.[�o,,,,l i�/OfiNu`zrry/�a/rlluk/fif/zm/6r,/!�„�in�/%r��/1/r/r,dale"/�/l�r urn,/i/,l//rl�ir�!(G�'y//w�/,,../ ,.��;,� r„ir11,/,/✓u, /fW