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HomeMy WebLinkAboutSoil Testing Results - 562 BOXFORD STREET 6/27/2017 'rOWN OF NORTH ANDOVER C,otttttattttity & EC011011lic Developtrtettt R IVED HEALTH DEPARTMENT ECE 120 Mainn ,Street NORTH ANDOVER, MASS ACI IUSL?`l,T 01845 Towg 0 978.688.9540 Phone � G) p,,g' i'NT 978.688.9542 FAX lrealthelept@tioilharndovea�-ina.gov www.northandoverma.gov , APPLICATION FOR SOIL TESTS 6/27/17 105.0-0003 DATE: MAP&PARCEL: LOCA'T'ION OF SOIL TES'T'S: 562 Boxford Street OWNER: Sirius Development, LLC Contact#: APPLICANT:Sergio Deassis Contact#: ADDRESS: 1033 Fellway Medford, MA 02155 ENGINEER: Christiansen &Sergi, Inc. Contact it: 978 373 0310 CERTIFIED SOIL EVALUATOR: Phil Christiansen `H 1—:,.7 YS Intended Use of Land: Residential Subdivision Single Family I�Pomc Commercial , YES. "T_ Is'T bls: Repair Testing: Undeveloped Lot`I"esting: Upgrade for Addition: (, , In the Lake Cochichewick Watershed? Yes No THE FOLLOWING MUST BE INCLUDED WITH THIS FORM S� Proof of land ownership(Tax bill,or letter from owner permitting test) t 8.5"4 ll"Plot plan&Lracnllan of Testin (please liudleate lest pit slies on the plan) Y Fee ol'$585.00 per lot for new construction. This covers the minimum two deep holes and two percolation tests required for each disposal area. Fee of$440.00 per lot for repairs or upgrades. GENERAL INFORMATION Y Only Certified Soil Evaluators may perforin deep hole inspections. Only Mass,Registered Sanitarians and Professional.Engineers can design septic plans. At least two deep holes and two percolation tests are required for each septic system disposal area. � % Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOIL representative. Full payment will be required for all additional tests within two weeks of testing. > Within 45 days of testing,a scaled plan(no smaller than I"-100')shall be submitted to the Board of Health showing the location of all tests(including aborted tests). > Within 60 days of testing soil evaluation forms shall be submitted. t Please Do Not Write Below This Line TN,A, Caaservrrtion Coxirrrrlsslon rodtrl Tla�": ll f la' Sl aerrfccre r� Conservation A c� Date frrrck to HeallPu UepefrriaeaR:'- a � - �60 36 .. A � `� O La 938 w w w w w w .I. Jn %` A1.r39 w w w w w O• w w w w a.,r A14(Y/ I, w w A r w w A11 cS A 1 w N w w A10 f A142 w w / rJ AVAILABLE SOIL. � � �••' TESTING AREA � � �� kA1,43 w w © C5►f � �,. w w 4 1 / -- 144 w �A O A 1 45 w A_14rr 120 ' _.� r. 6+ 46 o r y.. 20' 0 20' 40' SCALE:1"=20' Il Uolti7 �ii L..�y/�N N tK�w✓ l� � l=51 �y- Af TRI ah- oe jQy— C5 jt9d TP.� I I� y� f. ("j a W7 0.4 0"Th Town of North Andover HEALTH DEPARTMENT -SA 11 CHECK#: DATE: LOCATION: 8w,6 H/0 NAME: CONTRACTOR NAME: Type of Permit or License: (Check box) • Animal • Body Art Establishment $ • Body Art Practitioner $- D Dumpster $ 0 Food Set-vice--Type: 0 Funeral Directors 0 Massage Establishment $ 0 Massage Practice 0 Offal(Septic)Hauler 0 Recreational Camp 13 Sun tanning 0 Swimming Pool 0 Tobacco 0 Trash/Solid Waste Hauler 0 Well Construction $ SEPTIC�'�tenLs: )Ve "k Septic-Soil Testing $ X, ('0 0 Septic-Design Approval $ 0 Septic Disposal works Construction(DWG) $- 0 Septic Disposal Works Installers(DWI) $ 0 Title 5 Inspector $ 13 Title 5 Report (Indicate)_m Other: U,n Health Agent Initials White Applicant Yellow-Health Pink-Treasurer