HomeMy WebLinkAboutSoil Testing Results - 212 HAY MEADOW ROAD 9/7/2000 Town of North Andover, Massachusetts Form No. 1
NORTH ddeA"� BOARD OF HEALTH
,t LED �6,'VO 1Q L Il
O
APPLICATION FOR SITE TESTING/INSPECTION
RA ED
SSACHU5
Applicant NAME ADDRESS TELEPHONE
Site Location c2-
Engineer En
g N �g ADDRESS TELEPHONE
f
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
Fee Test No. �
I
S.S. Permit No.—D.W.C. No. C.C. Date Plbg. Permit No.
BO ARP 0;7 HEALTH
NORTH ANDOVER9 MA 01845
978-688_9540
APP PLIC vrirnN FORSOIL 'TES'TS
DATE: 7 MAP &PARCEL:
LOCATION OF SOIL TESTS: 2 k 2- t-W" vyt
OWNER: � TEL.NO.:
ADDRESS: '`2 VK I-A iu
ENGINEER: A) v- 1� TEL.NO.: �17E
CERTIFIED SOIL EVALUATOR: Y-,)e
Intended Use of Land: IA-
Residential Subdivision mgle Family Home Commercial
Is This:
Repair Testing: Undeveloped lot testing:
In the Lake Cochichewick Watershed? Yes No
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
1. Proof of land ownership (Tax bill, or letter from owner permitting test)
2. Plot plan & Location of Testing
3. Fee of$275,00 per lot for new construction. This covers the minimum tw deep holes and
two percolation tests required for each disposal area. Fee of$75.0 per lot o for repairs or upgrad
GENERAL A I. INFORMA ION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians 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. all additional tests within two weeks of testing.
5. Full payment will be required for 0ts)6. Within 45 days of testing, a scaled plan(no sma Iler th0 aborted of Health showing the location of all tests (including eshall be submitted to the Board
7. Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission App roval:
Date Received: Check Amount: Check Date:
UO
r '
LA Lij R
y LJ i I Q
+' C i t Jl
ul
Li
rL
Lo
� 1
Lr
-T
:L 1
. LD
I
I IN H
�i� �. •—t. — pow
..
rE-:,COL^,TION TEST
SCI i0NIDE, i7 Cyr= , ,C I: Lee,
WIE C. EC�-,.r.. _ ._ (,�. i���( ,-,ire:=- c
iIvIE - �'o) �__
r, I
IN E
IME STARTED
WE i _
I
V5
>r
1 � Y
r✓ksr r" Sr r .
r
r f
Al
`'
l / �i