HomeMy WebLinkAboutSoil Testing Results - 495 REA STREET 5/17/2002 Town of North Andover, Massachusetts
F NORTH BOARD OF HEALTH Form No. i
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APPLICATION FOR SITE TESTING/INSPECTION
��O�AATEO P?Ry.��J
SSACHUSti�
Applicant
NAME ADDRESS /V
TELEPHONE
Site Location � �°'` <
Engineer -' �
NAME w A DRE
TELEPHONE
Test/Inspection Date and Time
CHAIRMAN, BOARD OF HEALTH
Fee_-
Test No. J�?
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S.S. Permit NO. D.W.C. NO.-C.C. Date
Plbg. Permit No.
BOARD OF HEALTH
NORTH ANDOVER, MA 01845
978-688-9540
APPLICATION FOR SOIL TESTS
DATE: IN -OZ- MAP &PARCEL: 1 .3
LOCATION OF SOIL TESTS:
OWNER: �� TEL. NO.: I ' 1,3
ADDRESS: qj 5
ENGINEER: TEL. NO.:
CERTIFIED SOIL EVALUATOR: U/ S✓ �'—
Intended Use.of Land: Residential Subdivision 1 y Ho 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$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$200.00 per lot for repairs or
Wgrades. (If time is not critical, fee for repairs is$75.00)
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
3. At least two deep holes and two percolation tests are required for each septic system disposal area.
4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the
BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
6. Within 45 days of testing, a scaled plan(no smaller than 1"-100') shall be submitted to the Board
of Health showing the location of all tests(including aborted tests).
7. Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval: Yyuo!,f
Date Received: Check Amount: Check Date:
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hereby certify j bj er S. , tlsat the building
' on t4a property is loc' ted' as shovii <�n ,
plan 4nd oc IMPItes with the •�uiI ding'
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. 4oning'haws of the Tew of Np: Andover. i
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Location• � owner's Name: �kt-Eh �IQ An
Map/Parcel:—rk 3y I` Address: r3
Installer- Tel#: 1—19 ft New tsisol Repair
Date: G 3•dam Wetlands_k—vZone H Soil Symbol(—Soil Nam Soil Class
Deep Observation Hole Logs
Elevation Depth Soil Horizon Soil Te=re Soil Color Soil Mottlina % Gravel,Stones,etc:
AN,, W,
V.I�iG �`J, 2.SY5y� 5'fG/
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Parent hlateriai 1-1 L L Depth to Bedrock Standing.\Pater in the Hole: weeping.from Pit Face$LESHM:_
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Parent A4aterial Depth to Bedrocl: Standing.NYater in the Holr. weeping.from Pit Face ESHGw:
Date X1 Percolation Tests
Observation Hole# f'�
Depth.of Perc
Start Pre-soak
Time at 12" Lill,
Time at 9"
Time at 6' 7
Time(9"-6")
Rate Minflnch..•
Performed Bv: a, �9 Witnessed By: 51AM
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