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THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
......... --.�.&)�V ......... OF.......A41,P-0-K ..........................
Appliration for Disposal Works Tonstrurtion famit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at %r
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Location - A cess or t No.
Owner Address -
W
Installer Address //��
d Type of Building Size Lot�� � i� &CXq. feet
VDwelling — No. of Bedrooms......._________________________________Expansion Attic Garbage Grinder W41
PL4Other — Type of Building No. of persons ............................ Showers — Cafeteria
Pa Other fixtures --------• .............•-•-••--•-------------
W Design Flow.............................7.S.I.....gallons per person per day. Total daily flow ................... 4pt ..O ...........
W Septic Tank — Liquid capacity..4.. gallons Lpgth../D ........ Width ..... 6. .
...... Diameter ................ Depth._!a. _,o...
x Disposal Trench — No. _3 ............. Width ....... 3.......... Total Length .................... Total leaching area ....... sq. ft.
Seepage Pit No ..................... Diameter .................... Depth below inlet .................... Total leaching area .................. sq. ft.
Z Other Distribution box ( ) Dosing to ( ) r- /, p
aPercolation Test Results Performed by ........ -`1 :... 1 _ __1` -S.. Date..�3..APR -•6� ..._..
Test Pit No. I ...... (P ...... minutesperinch Depth of Test Pit ..... l2V.... Depth to ground water ----- �-__--_____.
Test Pit No. 2 ----- /3 ----- minutes per inch Depth of Test Pit.__....C?__. Depth to round water-___ (PQ ��
P P % - P g - -------------
O Description of Soil.....L,//U................................- - - - - - - - - -
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W-------•-•-----------------------•----------•------------------•-•-------------•----•---------•---•---------------------•••......-••-•-...............................................................
VNature of Repairs or Alterations — Answer when applicable...............................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code — The undersigned further agrees not to place the s stem in
operation until a Certificate of Compliance has been issued by the b(oard,4 health.
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402 Lowell Street
Andover, MA 01810
508-475-4958
Percolation Tests
Septic System Designs
Soil Surveys
STEVEN J. D'URSO
Registered Professional Sanitarian
New Hampshire Designer
Soil Scientist
/7 ��Gr d i
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bOIL WRVEYS - FEDERAL & STATE WETLAND DELINEATIONS - PERCOLATION TESTS * DISPOSAL DESIGNS
STEVEN J. D'URSO
Environmental Designs
Y 6
22 Lilly Pond Road
W. Boxford, MA 01921
(508) 352-9872
Date 9W
Balance ue upon receipt.
2% service charge on balances
not paid within 10 days.
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Town of North Andover, Massachusetts Form No. 1
,%ORTFI BOARD OF HEALTH
ED '�6 22&z*d 2 -,q
�0
APPLICATION FOR SITE TEST I NG/I NSPECTION
Applicant
Site Location-
-)Engineer / UJ2W
NW' TELEPHONE
Test/Inspection Di
of !OARD OF HEALTH
Fee oil
Test No, 4:4
07
S.S. Permit No. Plbg. Permit No.
,ED ,
Applican
Site Location
Engineer "'�' /
Town of North Andover, Massachusetts Form No. 1
BOARD OF HEALTH
APPLICATION FOR SITE TEST[ NG/I NSPECTION
Test/l nspection Date and Time
of 'ga
Fee—ls_
1315� -
CHAIRMAN, BOARD OF HEALTH
Test No. AL�
S.S. Permit No.------D.W.C. No._______C.C. Date-Plbg. Permit No.
'S. ,
Town of North Andover, Massachusetts Form No.1
BOARD OF HEALTH
APPLICATION FOR SITE TESTING/INSPECTION
19 -
Applicant
NAME ADDRESS TELEPHONE
Site Location
Engineer
NAME ADDRESS TELEPHONE
Test/Inspection Date and Time
Fee
CHAIRMAN, BOARD OF HEALTH
Test No,
S.S. Permit No.-D.W.C. No.-C.C. Date-Plbg. Permit No.
Apr -16-98 09:37A North Andover Coin. Dev. 508 688 9542 P.02
BO -A -RD OF HEALTH
00 SCHOOL STREET TEL., 688-9540
NORTH ANDOVER, MASS. 01845
APPLICATION FOR SOIL TESTS
DATE: 117
r7�'C'�
LOCATION OF SOIL TESTS:
Assessor's rt,,ap & parcel number: f14 -P1* /p
O'�VNER: 14 C-1) TEE L. NO.: SPI 7 o4
ADCRESS:dC�� Al
ENGINEER: G TEL. NO..
S?��.
r
CERTI iED SOIL EVALUATOR:
Intended use of and: residential subdivision, single family home, cornmercia.l
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM:
1
Proof,o.fland ownership (Tax bill, deep', or 1e"Er fr�m,own,er pErmitting
tests)
Plct'plan
Fee of $17r -,,GC per lot for new construction. This covers the minim c eep holes
araC Nvc percolation tests required for each disposal area. Fee<15 � 5.00 per is .or
repairscgrade
GENERAL INFORMATION
1. Only C2rified Soil Evaluators may perform deep "ole inspections.
2. Only Mass. Registered Sanitarians ar:d Prc#essional E^gir.eers car desicr : septic
plans. v
0. At least two deep holes and two percolation tests are required for each septic system
uisiosal 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 additicral tests witin Nvo weeks of testing.
6. Within 45 days of testing, a scaled plan (no smaller than 1 %1,30') shail be submitted to
the Board of Health showing the location of all tests (including aborted tests).
T Within e0 pays of testing soil evaluation forms shall be submitted.
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BOARD OF HEALTH
30 SCHOOL STREET TEL. 688-9540
NORTH ANDOVER, MASS. 01845
APPLICATION FOR SOIL TESTS
DATE.-
LOCATION
ATE:LOCATION OF SOIL TESTS:
Assessor's map & parcel number:_ /%( fn 7
OWNER:
0,0141-1) TEL. NO.: (P 1 % qv? 0 7� 0
ADDRESS'e��
ENGINEER: _ 1 ; 220 TEL. NO..-
a��q2
CERTIFIED SOIL EVALUATOR:
Intended use of land: residential subdivision, single family home, commercial
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 $175.00 per lot for new construction. This covers the minimum Lac—deeQ holes
and two percolation tests required for each disposal area. Fee $75.00 per to or
repairs pgrades.
GENERAL INFORMAT!ON
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.
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