HomeMy WebLinkAboutApplication - 24 DEER MEADOW ROAD 5/2/2016 9"
6
TOWN OF NORTH ANDOVER
office of COMMUNITY DEVELOPMENT AND SERVICES
HEALTH DEPARTMENT
1600 OSGOOD STREET; SUITE 2035
NORTH ANDOVER,MASSACHUSE'T'TS 01845
978.688.9540--Rhone
978.688.8476—FAX
E-MAIL:llealthdept@northandoverma.gov
WEBSITE:littp://www.jioi-tiiaiidovei'llia-go
SEPTIC P LAN SUBMITTAL,
FORM
RECEIVED
Date of Submission: 05/02/16 MAY U 3 201G
Site Location: 24 Deer Meadow Road, North Andover, MA J'OWN OF aTORPi ANDOVER
iTtALT'S DT:PAWNENT�
Engineer: Cornerstone Land Consultants, Inc. ) ^JJ�
New Plans? Yes X $275/Plan Check# 1094 (includes I" submission and one re-
review only)
Revised Plans?Yes $125/Plan Check#
Site Evaluation Forms Included? Yes X No
Local Upgrade Form Included? Yes X No
Telephone#: (978) 835-0102 Fax#:
E-mail: ken@cornerstoneland.net
Homeowner Chris Shanahan
Name:
OFFICE USE ONLY
When the subm sion is complete (including check):
Date stamp plans and letter
_ Complete and attach Receipt
t Copy File; Forward to Consultant
Enter on Log Sheet and Database
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Commonwealth of Massachusetts
City/Town of North Andover
Percolation Test
Form 12
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. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Important:When
filling out forms A. Site Information
on the computer,
use only the tab Chris Shanahan
key to move your Owner Name
cursor-do not 24 Deer Meadow Road
use the return Street Address or Lot#
key.
North Andover MA 01845
ray City/Town State Zip Code
Kenneth Lania, CLC (978) 835-0102
Contact Person(if different from Owner) Telephone Number
B. Test Results
03/31/16 12:30pm
Date Time Date Time
Observation Hole# TP#4
Depth of Perc
50"
Start Pre-Soak 12:54 pm
End Pre-Soak 1:09 pm
Time at 12" 1:10 pm
Time at 9" 1:46 pm
Time at 6" 2:41 pm
Time (9"-6") 55 min.
Rate (Min./Inch) 19 min/in
Test Passed: ® Test Passed: ❑
Test Failed: ❑ Test Failed: ❑
Kenneth M. Lania
Test Performed By:
Isaac, North Andover Board of Health
Witnessed By:
Comments:
t5form12.doc•06/03 Perc Test•Page 1 of 1
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