HomeMy WebLinkAboutApplication - 865 JOHNSON STREET 8/4/2014 I
TOWN N O NORTH ANDOVER
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Office of COMMUNITY DEVELOPMENTAND SERVICTS
M E11A T Vie .
1600 OSQ GOD STREET;Tg SUI l l+ 2035
NO1S
Ill ANDOVER, MASS SET'I'S 01845
Susan V.Savuer,tbERS,II.S 978.68 .9540 phone
Public Ile:alth Director 978.688 84'76 FAX
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www,townoffiorth udova:
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APPLICATION FOR SOIL TESTS
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DATE: MAP&PARCEL: (Y'7A ��
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LOCATION OF SOIL TESTS: Ti oyl � L 1 f rk,,,, i
OWNER; � C = Contact 0(o o
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APPLICANT: `'� t�tp Contact#:
ADDRESS:
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ENGINEER: JALI yd% Contact#:
CERTIFIED SOIL EVALUATOR: IL-+—
Intended Use of Land Residential Subdivisio Single Family Home Commercial NOW— Ids
p p g: Upgrade.. r Addition: )
Is This: Repair Testm develo ed Lat Testin fo
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In the Lake Cochichewick Watershed? Yes o
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THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
➢ Proof of land ownership(Tax bill,or letter from owner permitting test)
➢
8.5"x 11"Plot plait&Location of Testing(please indicate test nit sites on the plait)
➢ Fee of$425.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of 3$ 60.00 per lot for repairs or upgrades.
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.
➢ Repairs require at least two deep holes and at least one percolation test,at the discretion of the BOB
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 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:
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Signature of Conservation Agent:
Date back to health Department: (stamp in):
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North Andover MIMAP May 12, 2014
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Rail Line
Interstate,
--I Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83,
--SR Meters Data Sources:The data for this map was produced by Merrimack
Roads f NORTH q Valley Planning Commission(MVPC)using data provided by the Town of
V."r EasemeNS O 4Z,,CD s„ti� North Andover Additional data provided by the Executive Office of
? y a p Environmental Agalrs/MassGIS.The Information depicted on this map is
MVPC Boundary O for planning purposes only.It may not be adequate for legal boundary
definifion or regulatory Interpretation.THE TOWN OF NORTH ANDOVER
Municipal Boundary F" - MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
Trails ♦ - * THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
y e" i OF THESE DATA,THE TOWN OF NORTH ANDOVER DOES NOT
❑Parcels +F o9 * ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
Hydrographic Features "'"«"' �a
�.QS°4�reo �,t(5 THIS INFORMATION
Streams
-:Wetlands S'^CHUS�
Exempt Lands 1" 233 ft °
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