HomeMy WebLinkAboutApplication - 65 STANTON WAY 5/3/2013 0'
TO WN OF NORTH N OVER
Office of COMMUNITY DEVELOPMENT AND N.D SER171tr,ES
HEALTH, DEPARTMENT
1600(SCSI)(STREET; SIJI'I"E 2035
1`JC IfJ'H A DC)W,R, MASSAC fJt1SEJ-FS 01845
978,68 .9540_.Phone
Susan Y.Sawyer,62EiISOR:S 978.688,84 76...-FAX
Public Ilealtii Director E-MAIL: healtli(lej)t(c..Low�rioliiort47anclo er.coll!
WEBSI"T'`,. ttt lL//wwNu,towiio'Paioi°thandc7ver.corxl
SEPTIC PLAN SUBMITTAL FORM
Date of Submission: , 3
Site Location: Lot 16-3 Saracusa Way
Engineer: Christiansen & Sergi, Inc.
New Plans? Yes XX $225/Plan Check# (includes 1St submission and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Farms Included? Yes No XX
Local Upgrade Form Included? Yes No XX
Telephone#:978-373-0310 Fax#:978-372-3960
E-mail:-phil@csi-engr.com
Homeowner
Name:G.M.Z. Realty Trust
Applicant: Green & Company, 11 Lafayette Rd, No Hampton, NH 03862 800-429-8615
OFFICE USE ONLY
When the submission is complete(including check):
Date stamp plans and letter
➢ Complete and attach Receipt
Copy File; Forward to Consultant ' ° s"14 ^
r
Enter on Log Sheet and Database
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD F HEALTH
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PE I
Application for a Permit to Construct (� Repair ( ) Upgrade ( ) Abandon ( ) - °Complete System ❑Individual Components
Location ii LAA ve/{e f �t1. ��er�Na� 0H 03 y6L
Map/Parcel# Addr ss
1 --3 /-goo &6t5
Lot# Tel #
C'�a sh4vns6�( � se,?E2 .fin —
Installer's Name Des,gner's Name
I(o D YamrneC_ Sf , Nu WILh l/ /M e�1kJ�,
Address Address
61'79 ._� 73 --09 / 0
Telephoned/#+ Telephone#
&e
Type of Building: �5d r -F6-6'yn r`/ Lot Size `f 3619' Sq.feet
Dwelling—No.of Bedrooms 14 Garbage Grinder KO)
Other—Type of Building No. of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.required) YL/b gpd Calculated desi,n flow gpd Design flow provided W) gpd
Plan: Date li If 7-0 L3 Number of sheets Revision Date
Title 5 ,e 'r Lot lG ctivG(CitsGL VLF (�
Description of Soil(s) L' .S
Soil Evaluator Form No.pn -k 1e Name of Soil Evaluator T 14ec-40r Date of Evaluation t�.f 6-ID7
DESCRIPTION OF REPAIRS OR ALTERATIONS 13
sa
The underlir Wi above described Individual Sewage Disposal System in accordance pith the peoyis�on'¢of
TITLE 5 and fusys tem i n operation until a Certificate of Compliance has been issued by the Board of Health.
-/Signed _ Date , / n r I)rH`1
Inspec ions
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM S/96