HomeMy WebLinkAboutApplication - 35 STANTON WAY 2/21/2014 NORTH ANDOVER 1 ..
TOWN OF
Office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER, MASSACHUSETTS 01845
978.683.9540—Phone
Susan Y.Sawyer,REHS/RS 973.638.3476—FAX
Public Health Director E-MAIL: heal thdeptttdtownofnorthandover com
wEBSITE: htti)://www,townofnorthan(lover.com
SEPTIC PLAN SUBMITTAL FORM
,.
Date of Submission:
Site Location: Lot 16-1 Saracusa Way
Engineer: Christiansen & Sergi, Inc.
New Plans? Yes XX $225/Plan Check# 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 9: 078®373-0310 Fax #: 978-372-3960
E-mail: phil@csi-engr.com
Homeowner
Name ItTTst CO. t B ;wwda„B °I
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
Enter on Lag Sheet and Database
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
aWld OF BOARD r®F HEALTH D
APPLICATION FOR IS ®SAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct y Repair ( ) Upgrade ( ) Abandon ( ) - Complete System ❑Individual Components
Location � 1I e.iq-!(Xy eHe— �,P Ov�er'sName
Map/Parcel# 2g
Lot# ( Tele hone#
PJ
Installer's Name Designer's Name
Address Address
Telephone# Telephone#
Type of Building: 61M6( Fl+Ivt t L Lot Size V-3 571/ �Sq.feet
Dwelling—No.of Bedrooms V Garbage Grinder ( W6
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.required) gpd Calculated design flow gpd Design flow providedy�b gpd
Plan: Date '//2-d It,�, Number of sheets 7 - Revision Date
Description of Soil(s)
Soil Evaluator Form Noft -We, Name of Soil Evaluator T/-((?C � Date of Evalu do 2, v �7
DESCRIPTION OF REPAIRS OR ALTERATIONS e osyeod `�Z 72 o< 7�1� ✓/C�
The under ' Ggrees tc in,tall th above described Individual Sewage Disposal System in accordance with the provisions of
TI LE 5 and rt s tern in operation until a Certificate of Compliance has been issued by the Board of Health.
Signe Date
Ins CHO
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
a
�yrj 1C 'd1f
TOWN OIL NOR°I II ANDOVER
Office of C0M.M1JNITY DEVELOPMENT T .ND SERVICES
HEALTH DEPARTMENT
1600 OS(.,'001)STREET; SUITE 2035
NORTII ANDOVER,MASS,ACfiUSFTTS 01845
978.688 9540 _Mine
Susan Y.Sawyer,REIIS/RS 978.688.8476 FAX
Public Health Director E-MAIL: ��eal•�l�de itawa�c>frrart1��77c1w��vrz.cc�rr�
WEBSITE: htt;p?//ww�v.towtiof'jiott�thaazclover.cotn
SEPTIC PLAN SUBMITTAL FORM
RECEIVED «
Date of Submission: Ll3
Site Location: Lot 16-1 Saracusa Way
T'OWN U[ PtU-t::°t ANGC II fit
Engineer: Christiansen & Sergi, Inc.
New Plans? Yes XX $225/Plan Checic# (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):
i� Date stamp plans and letter
Complete and attach Receipt
r Copy File; Forward to Consultant
Enter on Log Sheet and Database
TRANSMITTAL SLIP
CS111 CHRISTIANSEN & SERGI, INC
160 SUMMER STREET,HAVE RHILt., MA 018:30
DATE: JULY 1,2013
SHIP Susan Sawyer
TO Public Health Director saracusa Way
Appravr;d S,r, pIi(; Systern Design I'llons
PROJECT NUMBER
ITEM# TION�pESCRIP
QUANTITY
A pp roved Septic Design Plans:
2 each lot
� I r
Lots 16-1; 16-2; 16-3; 16-5; 16-6; 16-7; 16-8; and 31
C7rigianl signed copies
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RE V °m
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IP`N dl�l tsl LI�.mW-t B E I A¢,f)k.)VI
H AL'T+I DI.PX-ZfN1E 1
RECEIVED 6Y:
Please contact Christiansen & Sergi at 978.373.0310 with any questions or comments.
THANK YOU FOR YOUR BUSINESS!