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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 I f I RE V °m 1 r 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!