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8 WYMAN AVENUE DEEP HOLE OBSERVATION FOR SEPTIC UPGRADE Ao'r-N�i , i CITY OF SALEM, MASSACHU'faceIVE BOARD OF HEALTH lu 98 WASHINGTON STREET,3RD FLOOR AUG 2 9 2023 PublicHealth SALEM,MA 01970 Prevent.Promote.Protect. 1 EL. (978) 741-1800 �OF c,�ALEM DOMINICK PANGALLO gpARD OF HEALTH health@salem.com OAVID GREENBAUM,RS,CHO MAYOR HEALTH AGENT APPLICATION TO SCHEDULE DEEP HOLE OBSERVATION r& PERCOLATION TEST Application to be completed by Soil Evaluator,Registered Sanitarian or Engineer Address of property to be tested: R � A , V V �_�_ -.Aue Map#: Lot#:'29 Upgrade New ons ction Upgrade with increas��''i"n flow Property OwnerAo�y Applicant(if different) Owner Address \0 Phone# Z Applicant Address (if different) t` hone# I 33-( � `Z3 Soil Evaluator Name�� Phone# 9 1 Is the Soil Evaluator a current licensed Massachusetts State Soil Evaluator?LO/N If yes, list license# 7-2-4O (If no, individual cannot perform soil evaluations) Company Name Distance to nearest wetland resource area -V Soo _ Was a Notice of Intent Filed with Conservation?Yes No Has the parcel been tested before? © If yes, date(s) of testing ore soil testing is performedT Will the property be DIG SAFE certiN Has a trench permit been filed with the City of Salem for the soil testingN Signature of owner or owner's agent - Print name _ Q Signature of applicant(if different) Print name Fee: $180 per lot for upgrade or repair, $225 per lot for new construction (Please make checks payable to the City of Salem) Plot plan of property required with return application that shows presumed location(s) for testing. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED SOIL EVALUATOR MUST CALL FOR A TESTING DATE AFTER THE COMPLETED APPLICATION AND FEE MUST HAVE BEEN RECEIVED IN THE BOARD OF HEALTH OFFICE trrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■rrrrrrrrr■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr FOR OFFICIAL USE ONLY Date Received: a J,7 Z Fee: — Received By: I-s-z' File VKMbff; 230WB-7 UNREGISTERED LAND Aftomy., LAW OFF.OF ROSEMARY TRAINI,LLC Deed Book Pare Lender: APEX CAPITAL LLC Plan Book PQ a Lot S owner. PATRICIA KNUUTTILA REGISTERED LAND R .Book Sheet Lot(a): I 5/12/2023 CrxlIC.— of 17tk 86486 Assessor Map Wk. Lot Censxs Tracy MORTGAGE INSPECTION PLAN Scale: I"SEC IV EDA 8 WYMANAVENUE, SALEM, MA W AUG 2 9 2023 Cay O' SALEM Uqct_,L4 -r VgRp HEALTH r � LET� CfPP1J S t 29&30 L109,78" koco W YMAN AVENUE CERTIFIGiTIOA' HE VAIN BUILDING,FOUNDATION OR D\YELLING WAS IN C'OMPLIANC'E WITH I'llE LOCAL BYI,A\1 S IN'F.FFEC'T\ It ONSTRUCTED(W IT[I RESPECT TO ST RUC TURA1.SETBACK REQ1-1RE?IENTS ONLY)OR IS EXF.\IPT FROM\TOL.%TIOX EN FORCE NIENT A('TION UNDER?PASS.GENE AL L%W TITLE YH.CHAPTER 40A,SECTION 7. FLOOD DETF.RAIIN4TION BY SC'AI.E.'rHG DWELLING SHOWN I IERE DOES NOT FAIL WITHIN A SPECIAL FLOOD[].VAR[)ZONE AS DF.LINF.XITI)ON A MAP OF COMMUNITY 25009C0531G AS 7.ONF.X DATED 07,'W201-i BY THE NATIONAL Ft.()(]D INSURANCE PRO(MAM. y 1, a., Oide Stone Plot Plan Service,ZLC P.O.Box 1166 Lakeville,MA 02347 Tel:(800) 993.3302 f Fax:(800) 993-3304 ` - PLEASE NOTE: This inspection is not the result of an instrument survey.The structures as shown are approximate only. An instrument survey would be required for an accurate determination of building locations,encroachments,property line dimensions,fences and lot configuration and may reflect different information than shown here. The land as shown is based on client furnished information only or assessor's map B occupation and may be subject to further cut-sales,takings,easements and rights of way. No responsibility is extended to the landowner or surveyor,or occupant. This is merely a mortgage inspection and is not be be recorded.