HomeMy WebLinkAboutApplication - 275 HAY MEADOW ROAD 4/24/2008 kECOVED TOWN OF NORTH.ANDOVER �NOR7N 1
APR 2 2008 Office of C�� IUNITY DEVLIL,OPMENT AND SERVIC S tipoG
HEALTH DEPARTMENT
NORTH ANDOVER 1600 OSGOOD STREET; BUILDING 20; SUITE 2-36
CONSERVATION COMMISSION NORT14 ANDOVER,MASSACHUSETTS 01845 SSICH
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Susan 'Y.Sawyer,REHS,RS 978.688.9540- Phone
Public health Director 978.688.8476- FAX w 5� ;.
healthdept�r�townofnorthand ver.ro�n
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www.townofiiorihandovenc m
rAPR 2 8 2008
APPLICATION FOR SOIL, TESTS
TOWN OF NOM'H POW)("wini-� d
DATE: '` 1 } , ! HEALTH f-F-.PA.RTN1,f NT
MAP&PARCEL' —
LOCATION OF SOIL TESTS:
OWNER: {`� -lti(i � ~� Ii�'r✓��, („1�-Q , l�Contact#: (v��"=
APPLICANT:--- �I Contact#:—_6��'1J tom°'-
ADDRESS:
ENGINEER: H �j3 a XI Contact#: - 7M q-�5j —
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision mgleTa Homy Commercial
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
D Proof of tend 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 o 60A0 bier 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.
> FulI payment will be required for all additional tests within two weeks of testing.
> 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).
Y Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval mate 0
Signature of Conservation Agent:_
Date back to Health Deparhnent:(stamp in):
MOR PLAN
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17 1ROYAL STREET, LAWRENCE, .MA. 01841 Tel. 508--975--1413
MORIT AGAR ya)A-MZ DEED FIEF. _ U/5" PC. 9 _
ADDP.ESS QF PRINCIPLE BUILDING: PLAN (REF. /pez9
27 (�4yMt"/�0dW D, DM O7 INSPECTI(1N
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