HomeMy WebLinkAboutApplication - 47 BOXFORD STREET 6/12/2007 `
`
TOWN CA N[>HTHANDOVER
Office of {�01M M U@!T\/ [lE\/EL[)R/I EN ANU SERVI CE")
1-1E4 \ T1-1 [}EF`IAJ-�T&JENT
1600{}BS0 0 DSTREETI BU|LD|N82O; SU|TE2-36
NURTHANDOVEf,�. TTSO1845
8usanY Sawvynr. REHS, RS 978888.8540 Phone
Pubi|oHea|thO/redor 978.688.8476 FAX
health e
DATE: MAP& PARCEL:
L`'^". .".. ". SOIL . E"."^ . . �
OWNER:- Pctcr Contact#
APPLICANT: Contact#
ADDRESS
E `GINEEIR
CER||M±U SOIL EVALUATOR: �
Intended Use of Land: Residential Subdivision Si ngl e Fami I y Home Commercial
IsThis: Repair Testing: t,�<ndeveloped Lot Testing:_ Upgradefor Additi-on:
THE FOLLOWING MUST BE INCLUDED WITH THISFORM
> Proof of land ownership(Tmx bill,or letter from owner permitting test)
�> 8.5-x 11.-Plot plan & Location of Testing(dease I ndicatetest pit sites on the plan)
> Fee of$42y5.00per lot for new cmnstruct|on. This ooverotha minimum two deep kNesand
two permo|ation tests requi red fnr each diopcsd area. Fee of83G0I0per |oLfor
GENERAL INFORMATION
> Only Certified Soil Evaiuedommay perform deep hole inspections.
> On|yK8aea Registered 8onitariema and Prof essionad Engineers can design septic plans. �
> At least two deep holes and two percolation tests are required for each septic system disposal area �
1
> Rep2jro require oL least two deep holes and sd least one percolation test, atthediecnetionoftheBOH /
representative. �
> Full paymentwiUbe required for 21| additional testevithin two woeksof testing. �
> Within 45days of testing, ascaied Pan(no smeller than1�1OO�slhd| besubmttedto the Board of Health
ahmwngthe|ocationofa]| tests(induding aborted basts).
> VVithinGO days uftestingsoi| ewauationf onmmehaUbasubmitted.
Please Do Not Write Below This Line
'
N.A. Conservation Commission Approval Dmhs
Signature uf Conservation Agent:
Date back to Health Department: (stamp in): �
q\A a,0
c.-�
,
7 `
C O _ J -
__ rS _
1
U\, (J) 5 :
M
Cu w
VO _ II
' C-17 r lC� -
CS) S\ Jl -
---
r� 4'5 2 1,0
-
� b
S>
C_CI
-P
C ,
u 0\11
;7