HomeMy WebLinkAbout- Soil Testing Results - 204 MILL ROAD 10/30/2018 C'onimtanity & Ecoitotkiic Developnievat
120 Mainn Street
N01'.I"lI AND OVER, 1 C.;HU [A`I' 01845
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APPLICATION FCDC SOIL TEST
BATE: October 23, 2018 MAP&PARCEL.: 107A/63
LOCATION OF SOIL TEs,TS: Right Side of House(see sketch plan)
OWNEM: Frank Ventola Contact 11: 978-771-5196
APPLICANT:Same as owner _.. ......_ -.. _.._ —Contact#: ._..._....... �_w._... .t
ADDRESS: 204 Mill Road North Andover, MA 01845 _....._ .. ...----__..._
ENGINEER: Jack Sullivan Contact 11: 781-854-8644
C1�,RTIFIED Soil.,EVALUATOR: Same as Engineer _...._. —
Intended?Use of Land: Residential Subdivision Single Family Home Commercial
Is This: Repair Testing: X - Undeveloped Lot Testing:- Upgrade for Addition:
Irt the Lake Cochichewick Watershed? Yes --.__.. Nd>.., ....._...._._. _
THE FOLLOWING MUS'lI BE INCLUDED WITH THIS hORM
7 Proof of land ownership("Tax bill,or letter from owner permitting test)
8.5"x,11"I''lol Blatt cfc Locatiarr o 7eslitr X rlease itnHctrte test pit sites on lire plan
Fee of$5$5.00 per lot for new construction. This covers the minimum two deep Doles and
two percolation tests required for each disposal area. Lee of "4�0 per lot for rct airs or itds,
GENERAL,INFORMATION
> Only Certified Soil Evaluators may perform 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.
7> Repairs require at least two deep holes artdl at least one percolation test,at the discretion of the 1301-1
representative.
Full payment will be required for all additional tests within two weeks of testing.
Within 45 days oftesting,a scaled plan(no smaller than 1"-100')shall be submitted to the Board onjealth
showing the location of all tests(including aborted tests).
Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Belorv'This Line
N,1t. C'tttasereatiott Commission A1)j)raw111 Date.*
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Signattct•e of Conseeptttiau Agent:
Dcae hack to Heallh Dejmrlmenl: (slanri:in):
October 23, 2018
Frank Ventola
204 Mill Road
North Andover,MA 01845
978-771-5196
Re: Permission for Soil Testing—204 Mill Road
Health Department;
1, Frank Ventola, grant permission for soil testing on my property for septic purposes.
Sincerely,
Frank Ventola
Town of North Andover, MA Octoberp23, 2018
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Properly Information
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Property ID 107-A-0063-0000.0
Location 204 MILL ROAD
Owner VENTOLA,FRANK L,JR
MAP FOR REFE RENCE ONLY
NOT A LEGAL 1:7C)cIJMEN]
'rown 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 0910112018
Properties updated 091OV2018
ata "� A 4
Town of North Andover
HEALTH DEPARTMENT
1sA CN1JSt1 y
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CHECK#: '. DATE: « „'am, ;i
LOCATION: 2 0` 1
le
I-I/O NAME: ,/ ', _
CONTRACTOR NAME:
Type of Permit or License:(Check box)
❑ Animal $
❑ Body Art Establishment $
❑ Body Art Practitioner $
❑ Dumpster $,
❑ Food Service-Type:_........_. _ _ $
❑ Funeral Directors $ —
❑ Massage Establishment $
❑ Massage Practice $
❑ Offal(Septic)Hauler $._
❑ Recreational Camp $
❑ Sun tanning $.
❑ Swimming Pool $.._.
❑ Tobacco $
❑ Trash/Solid Waste Hauler $
❑ Well Construction $
SEPTIC Systems:
Septic-Soil Testing $ '
❑ Septic-Design Approval $
❑ Septic Disposal Works Construction(DWC) $ "
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $�
❑ Title 5 Report $
❑ Other:(Indicate)-- � $
H,,dlth Agent Initials'
White-Applicant Yellow-Health Pink m Treasurer