HomeMy WebLinkAbout- Soil Testing Results - 1015 FOREST STREET 12/3/2018 TOWN OF NORTH ANDOVER
Coinniunity & Ecoiioiiiic Developtie t
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HEALTH DEPARTMENT
10 Mainn street
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C'IR"'I'll ANIX.)V"1-4 , MAS ACI-USEI 1.TS 018,45
74l.688,9540 i'"hone
XN 978.68 .g542 FAX
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www.iioi-tliaridoveriiia.gov
APPLICATION FOR SOIL TESTS
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LOCATION. �...P i.` �3w.J I..1�.'.A,ryA.`..STS: a ~� L
K—D-—---j ff- ----.
OWNER: c/o Steve Cunha Contact#: 617-823-4738
_....__ _..__._..._.._ ._._-— -
APPIACANT ..._. 1 -._. ." ....__.. ___...._Contact#:
ADDRESS: 1015 Forest Street
E,N6JIN E;R: Jack Sullivan Contact 781-854-8644
C"l:?,R l'I "fll'1)SOIL t;VAI.,IIA'I'OR: Jack Sullivan (email:jacksu1153 a@comcast.net)
» _..__._._.__.._ __..._. _. �...._.__.
Intended Use of Land: Residential Subdivision Single Farmly I��fome Commercial.
Is This: Repair Testing:__X .. Undeveloped Lot'T"esting: Upgrade for Addition:___.___
In the Lake Cochichewick Watershed? Yes No �
THE FOLLOWING MUST BE INCLI.IDFD WITH THIS FORM
Proof of land ownership(Tax,bill,or letter from owner permitting test)
8.5"r:11 "Plot Plan&Location of Testinr rlease indicate test ft 'UA' rr the rlerrr
Fee caf fi a€35.00 per lot for new construction. This covers t arair..o' tw o deep holes and
two percolation tests required for each disposal area. Fe rf$440.00 per of for repairs or upgrades.
GENERAL INF( RMA�TIO
> Only Certified Soil E?valuators may perform deep hole ins s.
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 130I-I.
representative.
Y bull payment will be required for all additional tests within two weeks of testing.
Within 45 clays of testing,a scaled plan(no smaller-than l"-I 00')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:-.. �L-_,
_
Sil,nature arf'C'onser ration Agent.,_
Date back to Health Department: (stamp in):
Town of North Andover, MA November 29, 2018
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ID NOT A LEGAL DOCUMENT
MAP FOR REFERENCE ONLY
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
k this map.
Geometry updated 10/31/2018
�,' Data updated 10/31/2018
November 29, 2018
Stephen Cunha
1015 Forest Street
N. Andover, MA 01845
Re: Permission for Soil Testing
1015 Forest Street,North Andover
Board of Health;
As owner of the above property I grant permission for soil testing for a future septic
system.
Sincerely,
Stephen Cunha
'own qf North Andover
HEALTH DEPARTMENT
DATE:CHECK#:
Z
H/O NAME: (21,4`
CONTRACTOR NAME:
Type of Permit or License:(Check box)
• Animal $
• Body Art Establishment $
• Body Art Practitioner $
0 Dunipster
• Food Service-Type:_
• Funeral Directors $
• Massage Establishment $
0 Massage Practice $
• Offal(Septic)Hauler $
• Recreational Camp
0 Sun tanning $
• Swimming Pool
• Tobacco
• Trash/Solid Waste Hauler $
• Well Construction $
SEP77C tems.
Septic-Soil Testing $
0 Septic-Design Approval $
0 Septic Disposal Works Construction(DW0 $
0 Septic Disposal Works Installers(DWI)
0 Title 5 Inspector
0 Title 5 Report $
0 Othen(Indicate)— $
. .........
UfiHe th Agent Initials
White-Applicant Yellow-Health Pink-Treasurer