HomeMy WebLinkAboutMiscellaneous - 1423 SALEM STREET 4/30/2018 (35) `- BOARD OF HEALTH
NORTH ANDOVER, MA 01845
978-688-9540
APPLICATION FOR SOIL TESTS
DATE: " MAP &PARCEL:
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LOCATION OF SOIL TESTS: Y23
OWNER: y- /A TEL. NO.: y"V %��` - �o 0 v
ADDRESS: 3 �
ENGINEER: TEL. NO.: 7-/7- �S ,
CERTIFIED SOIL EVALUATOR: `if 1G/ISS )�� �L?
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Intended Use of Land: Residential Subdivision Sin le Family Home Commercial
Is This: /
Repair Testing: V 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. PlotIan & Loc
p anon of Testing
3. Fee
f
o $425.00er lot for new construction.. This covers the minimum two d es and
two percolation tests required for each disposal area. Fee of$200.00 per lot far repairs or
upgrade (If time is not critical, fee for repairs is $75.00)
GENERAL INFORMATION
73020
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
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N.A. Conservation Commission Approval: !� ,-----
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Date Received: '''
Check Amount: Check Date: bz Ae
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