HomeMy WebLinkAboutApplication - 53 WHITE BIRCH LANE 2/6/2006 TOWN OF NORTH ANDOVER NORI
Office of COMM JNITY DEV +'LOPMENT AND SERVICEIS
HEALTH DEPARTMENT
400 O S O D STREET
NORTH ANDOVER, NIASSACHI_JSETTS 01845
078.685.9540-Phone
Susan Y.Sawyer,R"EIIS/RS 07k3.68.8.84�6 1 AX ,"
Public Health Director E-.VIAIL:hcalthde t�)town`:' ortha)a(k ' '<i
WEBSITE:htt ://ww .townofinorthandover.coni
SEPTIC PLAN SUBMITTAL FORM F EB 1. o 200
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Date of Submission:
Site Location: 1J 14 IT-C 0 1 12c
Engineer: fr t" kr L- I&) I
New Plans? Yes ✓$225/Plan Check# 5LI S (includes I st submission and one re-
review only)
Revised Plans?Yes $75/Plan Check#
Site Evaluation Forms Included? Yes No
Local Upgrade Form Included? PA,Yes No
Telephone#: '" �� Z f�'' ' f Fax#: "�fir- '" 4 40-
E-mail: C c`)
Homeowner ,-
Name: �{ �!✓ L1 j 4 {s �ctj/, 6 u:;7
OFFICE USE ONLY
When the submission is complete (including check):
Date stamp plans and letter
5> 4"1 Complete and attach Receipt
)> Copy File; Forward to Consultant " "
Enter on Log Sheet and Database
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New(SISO'Repair
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Deep Observation Hole Logs
ElLwatfou Depth Son H61z-on Sall Te=,r,. Sall tolor SOD Mottling. % Gravel,S.tones,etc
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Date I'Molation Tests
Obsess ation Hole
Depth of Pere
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Mme at 9"
Time at 6"
Time(9"-61_
Rate?YlhLqnch--
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