HomeMy WebLinkAbout- Miscellaneous - 50 FARNUM STREET 9/4/2018 a
TOWN OF" NORTH ANDOVER
CommunityIIIIIIIIpI Po�tt�noinicDEPARTeveloptttent
11
,20 Mikinak Street
i"yOl'(N-1 AND VI"Ii"u, MASSACHUSETTS 01845
978,688,9540 Phone
978,688,954',:l 54',:l FAX
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APPLICATION FOR SOIL 'TEST'S
DATE: A,-r—s-r 2:7_, zeS._t,g_..._._.__._..__.... MAI)&PARCEL: _° a.a?; 107A, Pl*2cc-t- a7....
LOCATION OF SOIL TESTS: 50 F'A.F,WUM
OWNER: _..mrz__- Contact#: q7S.7'71 . ISIS 3........______----__
APPLICANT: �a��u e�� >✓+a��,c�� .._..._.._._._.__._..Contact fl:_..co7e,4`T(:?, ,q95 �
ADDRESS:
ENGINEER: nava.. TEVE....6.Ayj`P-;; _. .__.._._._ Contact#: 976.73`73.0310
CERTIFIED SOIL EVALUATOR: ;-Aakr✓az --e/,B48 C&m15 a..eA,"1G ac mCGA.ST.h.aT
Intended Use of Laud: Residential Subdivision Single Family Home Commercial.
Is This: Repair Testing: y! Undeveloped Lot Testing: Upgrade for Addition:
In the Lake Cockuiehewick Watershed? "Yes No
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
Prool'of land ownership(Tax bill,or letter from owner permitting test)
f1.5".v.11"170 Mara&Location of Testing(please ira(licate test pit sites on the plan)
Fee of$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 re airs or ur racles.
GENERAL INFORMATION
Only Certified Soil Evaluators may perf.`orm deep hole inspections.
Only Klass.Registered Sanitariaus 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 hales and at'least one percolation test, at the discretion of the 13011
representative.
> Fuull payment will be required for all additional tests within two weeks of testing.
> 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).
Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line
N.A. Conservation Commission Approval Date: � a 1
1
,5"i b Xaaratarre as Crearser°rraaticaraAgent: .���"- -�--�`... `�M ...�.. •�
Date[rade to Health Department: (stamp in):
Town of North Andover, MA August 27, 2018
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107.A-008H
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Property ID 107.A-0087-0000,0
Location 50 FARNUM STREET
Owner COLEMAN,MICHAEL F
NI(D V A k k C.,N. I OC 18MENNT
Town of North Andover,MA makes no claims and no
warranties,expressed or implied,concerning the validity or
accuracy of the GIS data presented on this map.
Parcels updated 09/01/2018
Properties updated 09/01/2018
J 'd
Town of North Andover
HEAL'rH DEPAItTMENT
CHECK #; ww DATE.
..........
LOCATION:
H/O NAME:
CONTRACTOR NAME: N 4, . ......
Type of Permit or License: (Check box)
• Animal
• Body Art Establishment $
• Body Art Practitioner $
0 Dunipster $
0 Food Service-Type:-----,-----— $
0 Funeral Directors $
0 Massage Establishment
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0 Massage Practice $
• Offal(Septic)Hauler $
• Recreational Camp $
0 Sun tanning $
0 Swimming Pool
11 Tobacco $
0 Trash/Solid Waste Hauler $
0 Well Construction $
SEPTIC Systems:
Septic-Soil Testing $
0 Septic-Design Approval $
0 Septic Disposal Works Construction(DWQ $
0 Septic Disposal Works Installers(DWI) $
0 Title 5 Inspector
0 Title 5 Report $
0 Other. (Indicate).— $
...............................
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alth Agent Initials
jVhjL-Applicant Yellow-Health Pink- Treasurer