HomeMy WebLinkAboutMiscellaneous - 59 ROCKY BROOK ROAD 4/30/2018 (35) BOARD OF HEALTI�
' NORTH ANDOVER, MASS. 01 45r,--- �~
978-688-9540 y OCT 2 9 2003
APPLICATION FOR SOIL TESTS "
DATE: I0°-7-q-0'12 MAP&PARCEL: !ftj ICA
LOCATION OF SOIL TESTS: K,0 A4
OWNER: V-0 0 alb � J40A,rJ tQ1F &il 9l L. TEL.NO.:
ADDRESS: �`+ 0WIVO CC. Pew,
ENGINEER: H6"1146,K- F-1A i PE i2-1 _ TEL.NO.: (3 7e)
CERTIFIED SOIL EVALUATOR: Fl L4-
Intended use of land: Residential Subdivisionmgl Fae�iruly Home Commercial
Is This:
Repair testing ✓ Undeveloped lot testing Upgrade for addition
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 construction. This covers the minimum two deep holes and two percolation tests
required for each disposal area. Fee of$360.00 per 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 on 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
N.A.Conservation Commission Approval:
Date Received: Check Amount: Check Date: