HomeMy WebLinkAboutHealth Permit # 8/5/2014 BOARD OF HEALTH
1.600 Osgood Street, Suite 2035
North Andover, MA 01845
978-688-9540
APPLICATION FOR ABANDONMENT
OT'SUBSURFACE DISPOSAL SYST'ENI
(.SEPTIC.SYSTEM)
Pursuant to Section 311 CMR 15.354
Of'the State Environmental, Code, Title V
Name �� � Phone °
Address _
r
Contractor hired for iwork.
Name / k'- r' Phone ..... ..
.w
A
Address /�� �� � i
_ .
Date for scheduled abandonment
The septic system at the above address has been abandoned according to Title V specifications.
Signature of Contract6r
Method of septic tank abandomrnent (check one). O removal O sandfill ( crush O other
Name of Offal Hauler
This form mist he returned to the North Andover Board of Health,
LE DO NOT WRITE IN THE SPACE BELOW
t HEALTH REPRESENTATIVES ONI Y
In pccting Agent tMie
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass. —J v1-1-1
Application by the undersigned is hereby made to connect with the town sewer main in Street,
subject to the rules and regulations of the Division of Public Works
The premises are known as No. Street
or subdivision lot no.
OwnerAddress
e /-,(,I —
Contractor Ad ressli�
A/
p li cant's Signature
All-
PERMIT TO CONNECT WI J4 S WER N
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at Street
subject to the rules and regulations of the Division of Public Works..
Dlyision of Public Works
By
Inspected by
Date
See back for rules and regulations
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13ewvex Service for 338 S uIein St
SEWER SERVICE FOR HOUSE NUMBER 338 SALEM STREET
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�0 e of Service; Sewer ;Size of Service: b "; Length of Serv.54.5 LF
V ro Bate Installed:August 4,2004;Type
P-, U
House No.338:Street:Salem St.Street;Depth to Pipe @ PILLS-0 VI;Chimney: _VF NOT TO SCALE
%AORTfj
BUILDING PERMIT oF�Y,Eo
TOWN OF NORTH ANDOVER 02
APPLICATION FOR PLAN EXAMINATION '
Permit No#: Date Received
'ti�SsaC us���5
Date Issued:
IMPORTANT:Applicant must complete all items on this age
C� G� "O ' '
LOCATION c� l
Rrint
PROPERTY OWNER
Pant 10 Year Struc#ure; yes no
MAP PARCEL ZONING'DISTRIGT: Nrstorc District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
l
❑ New Building One family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑Septic,' ❑
ell ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer.
DESCRIPTION OF WORK TO BE PERFORMED:
lamvve User 'YL dee w+ orC r 4 on"16
U k2 . �ctCe. G �U C Gf�C r
p Itlentifca ion- Please Type or Print Clearly' �,_
OWNER: Name:�'N� Phone������-�J 71;T
Address: '
Contractor Name. Phone,
Address
Supervisor's Construction L�cens
Horne Impro�ernent License i,
ARCH ITECTIENGINEER
Address:
FEE SCHEDULE:BULDINCv PERMIT:$92.00ON$925.00 PER S.F.
Total Project Cost:$
A
Check No.: '
NOTE: Persons contracting with un.. .Euve access to the guaranty fund
Signature of AgentlOwner.< Signature of contractor
Plans Submitted ❑ Plans Waived 0
Certified Plot Plan ❑ Stamped Plans ❑
-o�SEWERAGE DISP-OSAL--- ❑ Swilnining Pools E
Public Sewer ❑ Tanning/massage/Body Alt
L] Tobacco Sales � Food Packaging/Sales
Well �
Private{septic tank,etc. ❑ Pennanent Dumpster on Site
THE FOLLOWING SECTIONS ®F OFFICE ARM E ONLY
INTERDEPARTMENTAL SIGN
PLANNING & DEVELOPMENT Reviewed On _ _
Signature_
COMMENTS
CONSERVATION Reviewed on
5i nature
COMMENTS
HEALTH Reviewed on
Si nature
--
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceipt submitted yes
Planning Board Decision:
Comments
Conservation Decision:
Comments
Drivewa Permit
Water & Sewer Con nection/Sliq nature & Date
DPW Town Engineer; Signature: Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dempster onsite yes
no
Located at;124 Main Sfreet
Fire Department signaturefdate