HomeMy WebLinkAboutApplication - 445 FOREST STREET 10/18/2006 TOWN OF NORTH ANDOVER o� �ORTM
Office of COMMUNITY DEVELOPMENT AND SERVICES
a
HEALTH DEPARTMENT
40ff OSGOOD STREET 4$
NORTH ANDOVER, MASSACHUSETTS 01845 �'ssACHU$`
978.688.9540—Phone
Susan Y.Sawyer,REHS/RS 978.688.8476—FAX
Public Health Director E-MAIL:healthde t(,townofnorthandover.com
WEBSITE:http://www.townofnorthandover.coni
SEPTIC PLAN SUBMITTAL FORM
1
Date of Submission: r Q ,�a�� c7 00(e) OCT 2 a 2006
Site Location: y I`" �- f i . A/7 do
t°a C��@l, RTP l tilt B
l 6 &�tI P C & T
Engineer: ') Sc a 2Y � �� �� <
U 0
New Plans? Yes 225/Plan Check# (includes 1St submission and one re-
review only)
Revised Plans? Yes $75/Plan Check#
Site Evaluation Forms Included? Yes No
Local Upgrade Form Included? Yes No
Telephone#: Fax#:
E-mail:
Homeowner
Name
OFFICE USE ONLY
When the submission is complete (including check):
Date stamp plans and letter
Complete and attach Receipt
Copy File; Forward to Consultant
Enter on Log Sheet and Database
Commonwealth of Massachusetts
City/Town of AJ ,vOd vC K
Percolation Test
Form 12
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Important: A. Site Information
When filling out
forms on the
computer,use Nancy Wedge
only the tab key Owner Name
to move your 445 Forest Street
cursor-do not Street Address or Lot#
use the return
key. North Andover MA 01845
City/Town State Zip Code
reb 978-794-9793
Contact Person(if different from Owner) Telephone Number
B. Test Results
10-10-06 10:00
Date Time Date Time
Observation Hole# PT1
Depth of Perc 36'719"
Start Pre-Soak 10:07
End Pre-Soak 10:22
Time at 12" 10:22
Time at 9"
10:27
Time at 6" 10:33
Time(9"-6")
6 Minutes
Rate (Min./Inch) 2 Min/Inch
Test Passed: ® Test Passed: ❑
Test Failed: ❑ Test Failed: ❑
Thomas Hector
Test Performed By:
Randy Burley Mill River Consulting
Witnessed By:
Comments:
t5form12.doc•06/03 Perc Test•Page 1 of 1
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