HomeMy WebLinkAboutApplication - 1440 SALEM STREET 9/18/2009 TOWN 014` Nttl TH P `Ittt 1K1
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SEPTIC PLAN SUBMITTAL FORM
Date of Submission: rowN OF, ''OR::�.i11:A� �,C hviER,
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Site Location: ?
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Engineer: -. 7 � ;
New Plans? Yes $225/Plan Check# includes 1St submission and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes No
Local Upgrade Form Included? Yes No
Telephone#: / / Fax#:
ZrM
Homeowner
Name:
OFFICE USE ONLY
When the submission is complete (including check):
Date stamp plans and letter
Complete and attach Receipt
Copy File; Forward to Consultant ! 6
Enter on Log Sheet and Database
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Commonwealth of Massachusetts
City/Town of North Andover
Percolation Test
Form 12
,M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Oore usong this fobm, check with
the information must be substantially the same as that provided here
the local Board of Health to determine the form they use.
Important:When A. Site information
filling out forms
on the computer, John Da hlian
use only the tab Owner Name
key to move your
cursor-do not 1440 Salem Street
use the return Street Address or Lot#
key. MA 01845
North Andover state zip Code
r�
City/Town
Contact Person(if different from Owner) Telephone Number
. Test Results
8/18/09 11:10
D Date Time
Date Time
1
Observation Hole#
57"to 75"
Depth of Perc
11:10
Start Pre-Soak
11:25
End Pre-Soak
11:25
Time at 12"
12:30
Time at 9"
2:20
Time at 6"
110 minutes
Time (9"_6")
37 mpi
Rate(Min./Inch)
Test Passed: ® Test Passed: ❑
Test Failed: ❑ Test Failed: ❑
Frank Nichols, PE
Test Performed By:
Randy Burley, Project Manager N. Andover Rep.)
Witnessed By:
Comments:
Pere Test•Page 1 of 1
t5form12.doc•06/03