HomeMy WebLinkAboutSoil Testing Results - 145 FARNUM STREET 3/5/2003 BOARD OF HEALTH
NORTH ANDOVER, MASS. 01845
978-688-9540
APPLICATION FOR SOIL TESTS
DATE: 3 I °_-4 MAP&PARCEL:
LOCATION OF SOIL TESTS: 19,5- F142hu M s-j"ae e r
OWNERJb -bits 7 f/, ztjJe74 REIeHf(D TEL.NO.: 278' 6KQ/- 03-%'1
ADDRESS:-)q-5- fr7r2vru��7 �%r�c�4_ ,U r.r1� fj,+✓P 0V0 fZ1
ENGINEER:Nip c ej&L-,A" Ei c in it+y G TEL.NO.: elle- 686- 176b
CERTIFIED SOIL EVALUATOR: 19)CIY46L0 C.'. �,u Er/9 i'� , A t�t✓ C CeIryoia 061-
Intended use of land: Residential Subdivision Single Family Horne 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,deed, or letter from owner permitting tests)
2. Plot plan
3. Fee of$425.00 per lot for new construct' n.-- is covers the minimum two deep holes and two percolation tests
required for each disposal area. Fee 200 00 r lot for repairs or upgrades.
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.
C. 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 Wlow This Line
N.A.Conservation Commission Approval: &1XPPZ-z" AZT '"`° �i1G4" ".ACLIC i)bq (I" 44rLluc4 ggk�/�
Date Received: Check Amount: Check Date: /
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Town of North Andover, Massachusetts Form No. 1
NORTH BOARD OF HEALTH
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APPLICATION FOR SITE TESTING/INSPECTION
SSACHUS�'
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Applicant -
NAME r AD'PRESS TELEPHONE
Site Location � �� fL' = % ✓' "
Engineer:° , -`- 1r�:�y1c �,
NAME RESS 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.