HomeMy WebLinkAboutApplication - 30 STANTON WAY 5/13/2013 TOWN OF NORTH ANDOVER
Office of COMMUNITY DEVEI..,O PENT , N:D SERVICES
HEAurll DEPARTMENT
1,600 OSGOOD STREET; SUITE 2035
NORT11 ANDOVER,MASSAC'1-IU E TS 01845
978.(7`8,9540 Phone
Susan Y.Sawyer,REHS/RS 97K688.8476- FAX
Public Health Director E-MAIL: lieaEtlr xde�tlrr�awrtc��f oi,thandover.cr.>zii
WE BSC EE: h it l r://win±w.townof'iiortlzaiaclover.com
SEPTIC PLAN SUBMITTAL FORM
FtECEIVED
Date of Submission:
Y
Lot 16-7 Saracusa Way w "`°
Site Location:
foW,q d S'E,�k4.thttl 4 N GIIDO'��r,,R
Engineer:Christiansen & Sergi, Inc. ��' ar`v��q � `�° IC�uf.i"d° °
New Plans? Yes XX $225/Plan Check# �� �� (includes 1st 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
Y Copy File; Forward to Consultant
Enter on Log Sheet and Database
No. THE COMMONWEAL'T'H OF MASSACHUSETTS FEE
BOARD OF HEALTH
T-OWK) OF IV OR ('n AN)M VE 1G.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct (,_ Repair ( ) Upgrade ( ) Abandon ( ) - 9Complete System ❑Individual Components
Location Owner's Nam
(_7 n /11-d (9 r '
Map/Parcel# Add
R6 2 ss
Lot# Telephone#
Installer's Name 5-(,s� G7 //e 1V A D/ 3 1)
Address Address
17S'_,3 Z3 �3i d
Telephone# Telephone#
Type of Building: S1 al& --LM l M166Ca-- Lot Size 601 '?3 '7 Sq.feet
Dwelling—No.of Bedrooms Garbage Grinder 080
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.required) gpd Calculated design flow gpd Design flow provided gpd
Plan: Date 517 Number of sheets Revision Date
Title . q e i T 16-7 rS
Description of Soil(s) FA g .
Soil Evaluator Form No.6 A Name of Soil Evaluator 2 &V Date of Evaluation t211 d' 7 :'0W,
DESCRIPTION OF REPAIRS OR ALTERATIONS 13,051 wd -711q 10
The undersigned agrees to r tall the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and fur re peration until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspec ons
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96