HomeMy WebLinkAboutMiscellaneous - 49 ORCHARD HILL ROAD 4/13/1998 No. THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD ®F/ HEALTH
O F 80I"! l!
APPLICATION ISP SAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct MRepair ( ) Upgrade ( ) Abandon ( ) - ['Complete System ❑Individual Components
L cation Owner's Name
Nlap/Parcel# Address
r
/lot# 1 Telephone#
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Installer's Name Designer's Name
7v i =l�ps�,�p � /��r�(���,r />� l() �1 MMC i�l. �5 I rz-t i F9/$�L"12.<l1L _1A, 11 6163C
�s Address/ / ry Address
Telephone# Telephone#
Type of Building: irl6-yi'l" I��x:,'95(1'it¢ Lot Size ,(') Sq.feet
Dwelling—No.of Bedrooms Garbage Grinder ( )
Other—Type of Building 6,400 -SE OEI-7U; i" No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.required) gpd Calculated design flow 2 _�_ gpd Design flow provided 01 gpd
Plan: Date_Uk, IL b. I"'t' Number of sheets Revision Date
Title 5f.L> IC. &4S•1" l��d T 1 Zts ( I iL( ��'�L 1-1(,L rZ_0P4-V
Description of Soil(s) J' FU yt9 51/41U VJS 11.A).7 1,()/1"1'9 S(±V/0 S 61 1'114 19�d'J��.i� o I�
Soil Evaluator Form No. Name of Soil Evaluator) f7 C'.010V i,i.,C Date of Evaluation 1U.11 S` 7
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to insta a above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further agrees not to pl the m in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date 3
Inspections f
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
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Town of North Andover, Massachusetts Form No.
f OORTN BOARD OF HEALTH
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�A'•�°� -� DESIGN APPROVAL FOR
9SSAC"°S" SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant Test
Site Location
m
Reference Plans and
ENGINEER DESI N DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
(d j A " L
CHAIRMAN,BOARD OF HEALTH
Fee �O�'® Site System Permit No. BEd
SEPTIC PLAN SUBMITTALS
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LOCATION:- - ✓ 2 f C ,=>� �. ,- f �( lj
NEW PLANS: % YES-- S60.00/Plan
REVISED PLANS: YES $25.00/Plan
DATE:
DESIGN ENGINEER:
When the submission is all in place, route to the Health Secretary