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TOWN OF M ANSFIELD, MASSACHUSETTS
50 West Street, Mansfield, MA 02048
PERC NO.
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DATE'.-- "
PERC
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APPLICATION FOR ON -SITE SEWAGE TESTING
SUBDIVISION f�; ( ! Fri t� '`7 (;' r. LOT NO._
OWNER TELEPHONE
ADDRESS
FEE $75.00
A16
CITY STATE
APPLICANT TELEPHONE
ADDRESS CITY STATE
ENGINEER i �1,3,��iyf r TELEPHONE
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ADDRESS ! ,i ;JS'`i l 4� a CITY V°1 Ca7t='l. STATE
1. In order for the Board of Health to take action on the application, you
must get numbered address from the Assessors Office at the Town Hall. No
application will be accepted without this information.
2. Fee is $ 75.00 per lot. Application and fee must be filed ten (10) days
before testing date.
3. Percolation testing and groundwater testing may be done all year.
4. You must know before the Town's Agent comes out to your lot where the
on -site sewage test is to be done.
5. Requirements needed at time of testing:
a. Your own engineer.
b. Backhoe or similar equipment to dig 10-12 feet.
C. Enough water for on -site sewage testing.
d. Sufficient 4" pipe for a monitor well.
6. Permit will become invalid if percolation test is not performed within one (1)
calendar year, provided that testing has not been suspended by the Board of Health.
Fee is non-refundable.
7. All septic system plans and DWCP applications must show soil testing number,
address and lot number.
Original to Board of Health, 1 copy for Treasurer's Office and Applicant
Revised October 1989
Revised March 1991