HomeMy WebLinkAboutApplication - 88 HAY MEADOW ROAD 4/19/2000 Town of North Andover, Massachusetts Form No. 1
NORTH dA BOARD OF HEALTH
APPLICATION FOR SITE TESTING/INSPECTION
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Applicant
NAME ADDRESS TELEPHONE
Site Location 45e
Engineer
N E _ ADDRESS TELEPHONE
Test/Inspection Date and Time
CHAIRMAN,BOARD OF HEALTH
Fee_
�� Test No.
S.S. Permit No. D.W.C. No. - C.C. Date Plbg. Permit No.
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BOARD OF HEALTH
NORTH ANDOVER, MA 01845
978-688-9540
APPLICATION FOR SOIL,TESTS
DATE: `� ° + 3 - - c- MAP & PARCEL: $ 1 r y P^ 6 w R o.
LOCATION OF SOIL TESTS: f .ra 'r s k c k
OWNER: G A R -c Sc o c. A TEL, NO_:
ADDRESS: tr g f s-t y ,M 6 Q w o
ENGINEER: J v-i A r r 6 c ,A T ,-r TEL. NO.:
CERTIFIED SOIL EVALUATOR: j a r4 W' c o o • ,� N
Intended Use of Land: Residential Subdivision in le Family Home Commercial
Is This:
Repair Testing: t/ Undeveloped lot testing:
In(he 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 two deep holes and
two percolation tests required for each disposal area. Fee of$75.0 0 per lot for repairs or upgrades.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections_
2. Only Mass. Registered Sanitarian 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.
5. Full payment will be required for all additional tests within two weeks of testing.
6. 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).
7. Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval:
Date Received: Check Amount. Check Date:
4-13-200 9.27AM FROM ROBERT E ANDERSON 15Q8 66u 81SS P. 3
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