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Home My WebLink AboutMiscellaneous - 22 Forest Streetro �esiJSfi Afictf 10-5 polyc"e) _j�arf'la v1 0 WP Qr cl 74,L-C-'*.'.,Dt7 m J— zZ- W� Lot & Street Has plan review fee been paid: /( YES Plan Approval: Date: Designer: Conditions: Water Supply: Town Well Well Permit: Well Tests: Chemical Bacteria I Bacteria II Plumbing Sign -Off: Comments: Form "U" Approval Date Issued Conditions: Final Approval: Map/Parcel NO Permit# Approved by: Plan Date: .41 Driller: Date Approved Date Approved Date Approved Wiring Sign -off: Approval to Issue: YES By: NO ' All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other? YES NO Any Variance Needed? YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: CONDITIONS: Is the installer licensed? Type of Construction: New Construction: Issuance of DWC permit: DWC Permit Paid? DWC Permit # Begin Inspection: Excavation Inspection: Needed: SEPTIC SYSTEM INSTALLATION YES I P - REPAIR CONDITIONS: Is the installer licensed? Type of Construction: New Construction: Issuance of DWC permit: DWC Permit Paid? DWC Permit # Begin Inspection: Excavation Inspection: Needed: SEPTIC SYSTEM INSTALLATION YES NO NEW REPAIR Certified Plot Plan Review YES NO Floor Plan Review YES NO Conditions of Approval from Form U YES NO YES NO YES NO Installer: Passed: By: Construction Inspection: Needed: As Built Plan Satisfactory: YES: Approval of Backfill: Final Grading Approval: Date: Date: M M Final Construction Approval: Date: By: Certificate of Compliance: Approval: Date: YES NO F -- PH FM WHOCELL( Town of North Andover Office of the Health'Department Community Development and Services Division William J. Scott Division Director 27 Charles Street Sandra Starr North Andover, Massachusetts 01845 Health Director May 7, 2001 Joseph Serwatka, P.E. 31 Kendrick Street Lawrence, MA 01841 RE: Lot 22 Forest Street Dear Joe, Telephone (978) 688-9540 Fax(978)688-9542 This letter is to inform you that upon closer review of the site referenced above additional technical deficiencies were identified. • There is no detailed explanation as to the use of a field instead of the DEP preferred use of trenches. • Assuming there is approval of the use of a field, the proposed leaching field is not the minimum 900 Square feet as required by NA 9.01(1) We apologize for the late notice of the deficiencies, however they are of such significance to the basic design of the plan that they had to be addressed prior to it's approval. If you have any questions, please do not hesitate to call the Board of Health Office. Sincer �— Susan Ford, R. S. Health Inspector Cc: Harrigan file BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director November 15, 2001 Telephone (978) 688-9540 Fax (978) 688-9542 Joseph Serwatka 31 Kendrick Street Lawrence, MA 01841 j Re: Lot 22 Forest Street Dear Joe: This is to notify you that the revised plans dated 11/8/01 for Lot 22 Forest Street have been approved. If you have any questions, please do not hesitate to call the Board of Health Office at 978-688-9540. Sincerely, Sandra Starr, R.S., C.H.O. Health Director SS/smc cc: Hartigan j File plg 4s4s 4iq 1A�. �� BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Town of North Andover Office of the Health Department } Community Development and Services Division 27 Charles Street p North Andover, Massachusetts 01845 "SSACHU ` Sandra Starr Health Director November 1, 2001 Joseph Serwatka, P.E. 31 Kendrick Street Lawrence, MA 01841 Re: Map 105.1), Parcel 22 Lot 22 Forrest Street Version: 09/11/2001 Dear Mr. Serwatka: Telephone (978) 688-9540 Fax (978) 688-9542 This is to notify you that there are technical deficiencies on the plan cited above that must be addressed before final Board of Health approval. They are: 1. Missing invert elevation of Soil Absorption System 2. Discrepancy on Soil Absorption System size between site plan and profile and Soil Absorption System detail on page 2 Please address and resubmit plan. If you have any questions, please do not hesitate to call the Board of Health Office at 978-688-9540. Thank you. Sincerely, Sandra Starr, R.S., C.H.O. Health Director Cc: J. Hartigan S. Giles File S S/aem BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Town of North Andover, Massachusetts Form No. 2 BOARD OF HEALTH 0 DESIGN APPROVAL FOR SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM FA plil ", I M]e 2,8�0z'0'2112118-1 I A :� Test No. I A�l Site Location Reference Plans and Sp ENGINEER DESIGN Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN, BOARD OF HEALTH Fee - Site System Permit No. // I FORM 11 - SOIL EVALUATOR FOR -NJ Page 1 of 3 No. Date: Commonwealth of Massachusetts ljo • Al va a �5e , Massachusetts Soil Suitability Assessment ,for On-site Sewaee Disposal Performed By: w`J 1 Date: (— Z1 --GIS Witnessed By: G, egogoe o L=zoon Address or 1.« / Address. >w yw,+ p�� Loi 2 Z Tckphom I pew Construction N Repair ❑ wince Review Published Soil Survey Available: No ❑ Yes FA Year Published Publication Scale /'/.�� '`/0 Soil Map Unit Drainage Class �_........... Soil Limitations........................................................ _............... Surficial Geologic Report Available: No Q Yes ❑ Year Published Publication Scale ..... GeologicMaterial (Map Unit)............................................................................................................................. ....................... Landform Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes ❑ Within 500 year flood boundary No ❑ Yes ❑ Within 100 year flood boundary No ©Yes ❑ Wetland Area: National Wetland Inventory Map (map unit)..........................................................`............_..............._.............. Wetlands Conservancy Program Map (map unit)........................................................................................... Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ®Below Normal ❑ Other References Reviewed: kiDEP APPROVIED FORM - 12/07/95 FOR_%I 11 - SOIL EVALUATOR FORpq Page 2 of 3 Location Address or Lot No. 22. Opt -site Review Deep Hole Number T Date: Time: /D A , W , Location (identify on site plan) Land Use VV 0 D s Slope (96) Z. Surface Stones Vegetation s> Landform Position on landscape (sketch on the back) Distances from: Open Water Body 71d0 feet Drainage way >*0 feet Possible Wet Area 7600 feet Property Line y GJ,0 feet Drinking Water Well >I00 feet Other Weather Y DEEP OBSERVATION HOLE LOG' Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell] Soil Mottling Other .Structure, Stones, Boulders, Consistency, % Gravel) A,, 2. 5�y6 z. y Yes Parent Material (geologic) /7L�TGC%��i W Oepthto8e3rock• 7 /OD Depth to Groundwater: Standing Water in the Hole: ZD Weeping from Pit Face: ?,p Estimated Seasonal High Ground Water: DFP APPROVED FORM - t2r0119S FORA 11 - SOIL EVALUATOR FORh1 Page 2 of 3 Location Address or Lot No. j� a -Z. Z, On-site Review Deep Hole Number �i Date: 6 -Z I- ed Time: M0 / 6��420,weather Gj c� ti Location (identify on site plan) Land Use kv 10 ® i} 15 Slope (96) Surface Stones Vegetation o!�- eA 5- '5 ' Landform Position on landscape (sketch on the back) Distances from: Open Water Body 7100 feet Drainage way feet Possible Wet Area feet Property Line 7 Vj�> feet Drinking Water Well feet Other DEEP OBSERVATION HOLE LOG' Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other .Structure, Stones, Boulders, Consistency, % Gravel) D /0 i N Z, �5 v'JA% Parent Material (geologicl _- Q U -7—al Dept Ro8edrock• % Depth to Groundwater: Standing Water in the Hole: - g �l� Weeping from Pit Face: '�i� N Estimated Seasonal High Ground Water: `ZGi i DFP APPROVED FOfNt - 12/0719S FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. =OT Z 2 - On -site Review Deep Hole Number Daie: Time: JO -• Wd 4,04-" Weather Location (identify on site plan) Land Use W A jP 0 5 Slope (%) Z Surface Stones — Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body %/d,* feet Possible Wet Area X199 feet Drinking Water Well 7104 feet Drainage way 7 45;4? feet Property Line i J;'P feet Other DEEP OBSERVATION HOLE LOG' Depth from Surface (Inches) Soil Horizon Soil Texture (USDAI Soil Color (Munsell) Soil Mottling Other .Structure, Stones, Boulders, Consistency, % Gravel) 1g `� L `✓ �D yQ y Parent Material (geologic) j20 7 ji(//1-5 jL peptMogedrock: Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: 4a Z Estimated Seasonal High Ground Water: 7 �% .. DFP APPROVFD FORM - 1,210719S FOR_m 11 - SOIL EVALUATOR FOR1�t Page 2 of 3 Location Address or Lot No. ZZ I- 2 Z Opt -site Review Deep Hole Number �-' Date: Time: /0: V-;:4 4 Weather "�l a N N Location (identify on site plan) Land Use uo'0 0 5 Slope M 2- Surface Stones Vegetation Landform Position on landscape (sketch on the backl Distances from: Open Water Body 7/00 feet Possible Wet Area 7 /00 feet Drinking Water Well 7)0® feet Drainage way 7 feet Property Line % 90 feet Other DEEP OBSERVATION HOLE LOG' Depth from Surface (Inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other .Structure, Stones, Boulders, Consistency, % Gravel) t- �yl� 7- g 2y4 )0 11/6 7,519-44MIN '0 ,4-tj 49 Parent Material (geologic) Q UT �,(�//`-� Depthto%&ock. Depth to Groundwater: Standing Water in the Hole: � � Weeping from Pit Face: Estimated Seasonal High Ground Water: '2iZ 1� i DFP APPROVED FORM - 12/07/95 March 20, 2001 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School Street North Andover, MA 01845 RE: Title V review for new SDS at lot 22 Forest Street Dear Sandra, Enclosed find our review of the "Checklist for North Andover Septic System Plans" for the proposed new septic system at the above-mentioned site. The following is a list of technical deficiencies that Port Engineering has found. v The distribution lines need to be capped or connected together by unperforated pipe of the same materials specifications as required by CMR 15.251 (9). o Foundation drains are not shown as required by NA 8.02y. If you have any questions or comments please feel free to contact me. Paul D. Turbide, PE/PLS PORT ENGINEEGING Civil Engineers & - Land Surveyors A�1 One Harris Street PPR L Newburyport, MA 01950 (978) 465-8594 \\Server P\NABH\P2884\ FOREST ST LOT 22.DOC SEPTIC PLAN SUBMITTAL FORM LOCATION:_,P�-f I%iA� /a g',1� ��c�Z, 2 Z NEW PLANS: YES $125.00/Plan REVISED PLANS: $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES co DATE: DESIGN ENGINEER: DATE TO CONSULTANT: When the submission is all in place, route to the Health Secretary. �pR 20 2401 Town of North Andover Office of the Health Department Community Development and Services Division William J. Scott; Division Director 27 Charles Street Sandra Starr North Andover, Massachusetts 01845 Health Director May 7, 2001 Joseph Serwatka, P.E. 31 Kendrick Street Lawrence, MA 01841 RE: Lot 22 Forest Street Dear Joe, Telephone (978) 688-9540 Fax (978) 688-9542 This letter is to inform you that upon closer review of the site referenced above additional technical deficiencies were identified. • There is no detailed explanation as to the use of a field instead of the DEP preferred use of trenches. • Assuming there is approval of the use of a field, the proposed leaching field is not the minimum 900 Square feet as required by NA 9.01(1) We apologize for the late notice of the deficiencies, however they are of such significance to the basic design of the plan that they had to be addressed prior to it's approval. If you have any questions, please do not hesitate to call the Board of Health Office. Sincer �-- Susan Ford, R. S. Health Inspector Cc: Hartigan file BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 JUN -19-2001 01:40 PM JOSEPH J. SERWATKA 1 978 683 6595 P.01 1812001 Ms. Sandra Starr North Andover Board Health 27 harles Street North Andover, MA 0l $45 Re:lForest Street Hartigan Property Dei r Ms. Starr: Relative to your last review letter regarding the justification of a leach field versus leaching trenches, I offer the following comments. The subject site has an extremely high gro indwater with sandy soils. The leaching system therefore has to be mounded out of the gro Ind to meet groundwater separation requirements. As designed, the system has a leach fief i to reduce the overall height of the system. The garage elevation is currently at exi ting grade. If we are required to use leach trenches, the height of the system will be in eased and the garage elevation would have to be above existing grade. This increases the amount of grading and filling throughout the site and could create an unattractive situation. We therefore request that we be allowed to revise the plans with a 900 sq. ft. leach field and resubmit the plans. I will wait for your response to this letter prior to rev sing the plans. J. Serwatka, P.E. Mar -29-01 04:54P Paul D. Turbide, PE/PLS Civil Engineers & Land Surveyors One Harris Street Newburyporl, NU 01950 (978)465-8594 March 20, 2001 978-465-0313 Sandra Starr North Andover Board of Health Administrator Office of Community Development and Services 30 School Street North Andover, MA 01845 RE: Title V review for new SDS it lot' - Forest Street 1 Dear Sandra, P-05 Enclosed find our review of the "Checklist for North Andover Septic System Plans" for the proposed new septic system at the above-mentioned site. The following is a list of technical deficiencies that Port Engineering has found. o The distribution lines need to be capped or connected together by unperforated pipe of the same materials specifications as required by CMR 15.251 (9). o Foundation drat shown as required by NA 8.02y. \\Server PINABH\P2884\ FOREST ST LOT 22.DOC \ Town of North Andover Office of the Health Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 Sandra Starr Health Director May 14, 2001 Joseph Serwatka, P.E. 31 Kendrick Street Lawrence, MA 01841 Re: Lot 22 Forest Street Dear Mr. Serwatka: Telephone (978) 688-9540 Fax (978) 688-9542 This is to inform you that the proposed plans for the site referenced above have been disapproved because of technical deficiencies as follows: • The distribution lines need to be capped or connected together by unperforated pipe of the same materials specification as required by CMR 15.251 (9). • Foundation drains are not shown as required by NA 8.02y. Please note that a report on certified vernal pool locations from the North Andover Conservation Commission will be required before final Board of Health approval. If you have any questions, please do not hesitate to call the Board of Health Office. Sincerely, Sandra Starr, R.S., C.H.O. Health Director cc: Hartigan file BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 I iiiii=iri■�riirir�i■■�i iiiii �iiiiiii iiiiiii =roil=r ��■-��mmm �� i ■��imommumm■om MEN 0 iiiiiiiiiiiiiiii iimiiiir iiiiiiiiiii�iiiiiiii �■�� iiiiiiiiiiiii °miiiiiiiiiiiiiiiiii iimm =M��si -. i�iiiiiiiiiiiii rr 'liiiiiiiiiii Mill iiiiiii -I Mill-ai ii=iiioiiiiiii� 7iiiiiiii iiiiiii ii�i Jiiiiiiiiiii ilii 1liiiiiiiiiiiiiiii iilii ii a �4 �: "`..' — __ _,_.�.�._____._.._n ��.r.,__ _ _ .... ,.,._ r .�, � �.: - •- �: FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. Z' 2 Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole . inches ❑ Depth weeping from side of observation hole inches N Depth to soil mottles inches ❑ Ground water adjustment ................ feet Index Well Number .......... Reading Date ................. Index well level ... Adjustment factor ............ Adjusted ground water level .. ................ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? --G If not, what is the depth of naturally occurring pervious material? Certification I certify that on 44!��(date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature --,d Date DEP APPROVED FORAM - 12/07/95 FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS IVO - /A/049,4 V45�',< Massachusetts Percolation Test` 1 Date: �! Time: Od .5; Z Observation Hole # �_ _Z_ Depth of Perc Start Pre-soak End Pre-soak Time at 12" Time at 9" Time at 6" l/'t5 Time (9"-6") Rate Min./Inch * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed V1 Site Failed ❑ .............. ........ I............ Performed By:o S P, �. 'ie ,� Witnessed By: Comments: DEP APPROVED FORM - 12/07/95 FORM 12 - PERCOLATION TEST Location Address or Lot No. p—f —,7,�, COMMONWEALTH OF MASSACHUSETTS lUa, dv i2o L/ E41VIassachusetts Percolation Test` Date:/ , Z_/49 Od Time: Observation Hole # Depth of Perc Start Pre-soak End Pre-soak �d j /� 5" Time at 12" Time at 9" Time at 6" Time (9"-6") Rate Min./Inch 2 * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ .............................................................................................................................................. ....... Performed By: Witnessed By:� Comments: DFP APPROVED FORM - 12/07/95 SEPTIC PLAN SUBMITTAL FORM LOCATION: i Z D %- Z NEW PLANS: REVISED PLANS: YES $125.00/Plan $ 60.00/Plan SITE EVALUATION FORMS INCLUDED: YES NO DATE: 2! — 2. °� C-"/ DESIGN ENGINEER: 7 `> � DATE TO CONSULTANT: *If you want your plans expedited, please submit three plans and included a stamped envelope with the correct amount of postage to mail plans to Port Engineering. When the submission is all in place, route to the Health Secretary. No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH w Ail o f A90, 190 11 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to ConstructeK7Repair ( ) Upgrade ( ) Abandon ( ) - VComplete System [-]Individual Components Q 1 � / x o tion 0/ Loca !! Map/Parcel # Lot# Installer's Name Address Telephone # wn s ame &I Vizir Type of Building: �j/ AVS L e —L�- Dwelling — No. of Bedrooms 4 Other — Type of Building No. of persons Other fixtures Lot Size q Ae -3t Sia: Garbage Grinder ( ) Showers ( ), Cafeteria ( ) Design Flow (min. required) gpd Calculated design flow gpd Plan: Date 74 D % Number of sheets*. Revision Title GtJ.Gi 12 i s !' e� L-" i Description of Soil(s) _ U Soil Evaluator Form No. Name of Soil Evaluator DESCRIPTION OF REPAIRS OR ALTERATIONS Design flow provided J!�Ogpd Date of Evaluation d� The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Inspections Date FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated . Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Date FORM 2 - DSCP FORM 1255 (REV 5/96) Board of Health DEP APPROVED FORM 5/96 H&W HOBBS& WARREN TM PUBLISHERS - BOSTON Town of North Andover, Massachusetts Form No.1 ,�AORT#j BOARD OF HEALTH 6'6 —19 0 - - - - - - - - - - . . . . . . . . . . APPLICATION FOR SITE TESTING/INSPECTION Applicant NAME ADDRESS TELEPHONE Site Location Engineer NAME ADDRESS TELEPHONE Test/l nspection Date and Time Fee CHAIRMAN, BOARD OF HEALTH Test No. S.S. Permit No.—D.W.C. No._C.C. Date—Plbg. Permit No. Jun -21-00 12:07P Paul D. Turbide, PE/PLS 978-465-0313 P.01 Facsimile Cover Sheet To: SANDRA STARR Company: NORTH ANDOVER BOH Phone: 978-688-9540 Fax: 978-688-9542 From: Carlton A. Brown Company: Port Engineering Associates, Inc. Phone: (978) 465-8594 Fax: (978).465-0313 Date June 21, 2000 Pages Including This Cover Page: 4 Comments: Sandy, Enclosed are results of testing for Lot 22 Forest Road (by power lines) (4 deep holes were done, but do not charge extra) Thanks, Carlton BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: 4110 oo MAP & PARCEL: , LOCATION OF SOIL TESTS: c� r er�iT �7T • �.yT r3• OWNER: `` JA ,M S�-%2-r ► 6!A " TEL. NO.: � F� i Z/7, i 3 ¢ 3 ADDRESS: 3 G �✓ P2� n�� T D,�4 a/ V�� rVl� /tel 2 ENGINEER: To5g-yA,4 J-7 c1�,2,.yg�,� P9,TEL. NO.: CERTIFIED SOIL EVALUATOR: ! A ,yf 1E Intended Use of Land: dential Subdivisio Single Family Home Commercial Is This: Repair Testing: Undeveloped lot testing: In the Lake Cochichewick Watershed? Yes No X 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 $275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of V5.00 per lot for repairs or Lipgrades. GENERAL INFORMATION I. 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 Line1 & N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: April 18, 2000 To Whom it May Concern: I hereby authorize Joseph Serwatka to perform soil testing on my lot off of Forest Street in North Andover. Sincer ly, J es Ha 'gan BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: 4110 oa MAP &PARCEL: o LOCATION OF SOIL TESTS: a` OWNER: TA- vM E 3 ¢ 3�%g41 7 ADDRESS: b6, leg—)"g ENGINEER: P9,TEL. NO.: CERTIFIED SOIL EVALUATOR: Intended Use of Land: dential Subdivisio Is This: Repair Testing: Single Family Home Commercial Undeveloped lot testing: X In the Lake Cochichewick Watershed? Yes No X 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 $275.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests_ required for each disposal area. Fee of $75.00 per lot for repairs or up rg_ades. 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 MAY 16 N.A. Conservation Commission Approval: Date Received: Check Amount: Check Date: