HomeMy WebLinkAboutMiscellaneous - Lot 1 Salem Street9
JLot & Street ( Map/Parcel v
CONSTRUCTION APPROVAL
Has plan review fee been paid: YES
Plan Approval: Date:
Designer:
Conditions:
NO Permit#
Approved by:
Plan Date:
Water Supply: Town Well
Well Permit: Driller:
Well Tests: Chemical Date Approved
Bacteria I Date Approved
Bacteria II Date Approved
Plumbing Sign -Off: Wiring Sign -off:
Comments:
Form "U" Approval:
Date Issued
Conditions:
Final Approval:
Approval to Issue: YES
By:
ace
All Permits Paid? YES NO
Well Construction Approval? YES NO
Septic System Construction Approval? YES NO
Certification? YES NO
Other? YES NO
Any Variance Needed? YES NO
FINAL BOARD OF HEALTH APPROVAL:
DATE:
APPROVED BY: •
i
CONDITIONS:
Is the installer licensed?
Type of Construction:
New Construction:
Issuance of DWC permit:
DWC Permit Paid?
DWC Permit #
Begin Inspection:
Excavation Inspection:
Needed:
SEPTIC SYSTEM INSTALLATION
Certified Plot Plan Review
Floor Plan Review
Conditions of Approval from Form U
Passed: By:
Construction Inspection:
Needed:
As Built Plan Satisfactory:
YES:
Approval of Backfill: Date:
Installer:
By:
Final Grading.Approval: Date: By:
Final Construction Approval: Date: By:
Certificate of Compliance: Approval: Date:
YES
NO
NEW
REPAIR
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES NO
Town of North Andover, Massachusetts
T11 BOARD OF HEALTH
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APPLICATION FOR SITE TESTI NG/INSPECTION
Form No.1
19
Applicant
NAME ADDRESS TELEPHONE
Site Location
Engineer
NAM,E ADDRESS TELEPHONE
Test/Inspection Date and Time
F
I
CHAIRMAN, BOARD OF HEALTH
Test No.
S.S. Permit No.-D.W.C. No. C.C. Date-PIbg. Permit No.
Oct -31-00 10:07A Paul D. Turbide, PE/PLS 978-465-0313 P.02
Oct -31-00 10:07A Paul D. Turbide, PE/PLS 978-465-0313 P.01
Facsimile Cover Sheet
To: SANDRA STARR
Company: NORTH ANDOVER BOH
Phone: 978-688-9540
Fax: 978-688-9342
From: Paul D. Turbide
Company: Port Engineering Associates, Inc.
Phone: (978) 465-8594
Fax: (978) 466-0313
Date October 31, 2000
Pages Including This
Cover Page: 2
Comments:
Sandy,
Attached are field book notes for the soil evaluation at:
Lot 1 Salem Street
Two deep hale observations and two perc tests were completed on October 30, 2000
PoDFF
it I Thanks,
ENGINEERING Paul Turbide
Civil Engineers &
Land Surveyors
One Harris Street
Newburyport, MA
01950
(978)465-8594
BOARD OF HEALTH
NORTH ANDOVER, MA 01845
978-688-9540
APPLICATION FOR SOIL TESTS
DATE: MAP & PARCEL:
LOCATION OF SOIL TESTS:
OWNER: TEL. NO.:
ADDRESS: /
ENGINEER: i TEL. NO.:
CERTIFIED SOIL EVALUATOR:
Intended Use of Land: Residential Subdivision
Is This:
Repair Testing:
In the Lake Cochichewick Watershed?
g7,P 3.5Z-7X7Z.
Family Home
Commercial
Undeveloped lot testing:
Yes No
THE FOLLOWING MUST BE INCLUDED WITH THIS FORM
1. Proof of land ownership (Tax bill, or letter from owner permitting test)
2. Plot plan & Location of Testing
3. Fee of $275.00 per lot for new construction. This covers the minimum two deep holes and
two percolation tests required for each disposal area. Fee of $75.00 per lot for repairs or ude
pgras.
GENERAL INFORMATION
1. Only Certified Soil Evaluators may perform deep hole inspections.
2. Only Mass. Registered Sanitarians and Professional Engineers can design septic plans.
3. At least two deep holes and two percolation tests are required for each septic system disposal area.
4. Repairs require at least two deep holes and at least one percolation test, at the discretion of the
BOH representative.
5. Full payment will be required for all additional tests within two weeks of testing.
6. 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).
7. Within 60 days of testing soil evaluation forms shall be submitted.
Please Do Not Write Below This Line APR — 6
*�t h.N.A. Conservation Commission Approval:, L&�'w
Date Received: Check Amount: Check Date:
William S. MacLeod
I East River Place
Methuen, MA 01844
978-687-3828
/-/I, 514,00104
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