HomeMy WebLinkAboutApplication - 51 STANTON WAY 5/3/2013 r
TOWN OF NORTH.ANDOVER
Office of COMMUNITY ICE ELOPC°ENT Ai" D SERVICES p
1-1EAL14I. DEPARTMENT
1600 O GOOD STREET; SIIITE 2035
NC)RT11 ANDOVER, M11SSACTIL,fS T'I S 0184
<178.(i,`if 9540 Phone
�';us<�r� "i'.Sawyer, lt[�.F[ /�YS; 978,688.8476.... FAX
Prflalde Health Director E-M.hl'l'.. ttcnitl7ct� t(��towrA�:rfno�°t lxar7clawt,g.cc»n
WEB5CTL- http://ww�F.tc�wr��fn�7rthar��ld"wrr_cura�
SEPTIC PLAN SUBMITTAL FORM
Date of Submission: 3 h
Site Location; Lot 16-2 Saracusa Way
Engineer: Christiansen & Sergi, Inc.
New Plans? Yes XX $225/Plan Check# 6) (includes I" submission and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms 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 0
Copy File; Forward to Consultant
Enter on Log Sheet and Database
MAY C1 w N
}
H NJ I
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH
TQVJ&I — OF N 4 P.7t-I
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PE IT
Application for a Permit to Construct (� Repair ( ) Upgrade ( ) Abandon ( ) - 5&om lete System p y El Individual Components
15�91� 19 ih ` ( Crean J Carne m y
Location
l Own is Name, nJ(� ()38'ro
Lot rg/P,arcel# 1 -906 -
y: Address
t Lot#L_
Telephone#
s d»S� i
Installer's Name ST Desi er's Name.
Address
7O _'3_73 Address
Telephone# ,6 3 /6
Telephone#
Type of Building: _ ��I y1P�2 Yll
Lot Size Sq.feet
Dwelling—No, of Bedrooms Garbage Grinder (04)
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(mi re uired) Ll q� gpd Calculated design flow gpd Design flow provided W-6 gpd
Plan: Date 1 1 D1_-3 _ Number of sheets Z Revision Date
Title 0G r>skj?rn De
,c r�-„ l(nf /(� -� S�zr�2 cu c 1/ilcw, A .
Description of Soil(s) F M S
Soil Evaluator Form Noo3gR1 -- Name of Soil Evaluator f !4ee--,6r Date of Evaluation/ 67 �frlC�
DESCRIPTION OF REPAIRS OR ALTERATIONS `(`
The unders' d agre eto insta above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and f r gr not_ a a system in operation until a Certificate of Compliance has been,ssued by the hoard,of Health.
Si ne Date 3 i
Inspect' s 'Y U 3 '113
FORM 1 - APPLICATION FOR DSCP DE:P APPROVED FORM 5/96