TOWN OF MARSHFIELD
BOARD OF HEALTH
APPLICATION FOR PERCOLATION TESTS/SOIL EVALUATION
Instructions: Please complete this form and deliver or mail a check payable to the Town of Marshfield to the Marshfield Board of Health, Town Hall, 870 Moraine St., Marshfield, Ma. 02050. Checks should be made out in the amount of either (1) $50 for repairs to existing septic systems or (2) $50 for 1/2 day, or $100 for each full day requested for new construction (The balance for new construction hours witnessed by Board of Health will be billed out at $50/hour, and at $25/hour for repairs).
After payment is made, and your application is completed, the Board of Health will assign a date by contacting your engineer. It is your responsibility to secure a back hoe, notify your back hoe operator, and assure access and permission for all parties and equipment on the property to be tested.
Applicant Name _____________________________ Phone ______________
Mailing Address _________________________________
Responsible Party for future billing (for new construction) __________________
Signature of Applicant _________________________ Date signed __________
New Construction ____ Repair ____ (Check one)
Location to be tested ____________________________Map/Block/Lot______________
Owner of Location to be tested ___________________________
Amount of days requested ____
Engineer (P.E.) /Reg. Sanitarian Name __________________ Phone # __________
Soil Evaluator Name _________________________________Phone # ___________
__________________________________________________________________________________
BOH use only:
Date Assigned _________________________________
Notes:
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