HomeMy WebLinkAboutMiscellaneous - 130 WINDKIST FARM ROAD 6/30/2018 TONAIN OF NORT11 ANDOVER
Coentntenity & Economic Development
HEALTH H DEPARTMEW
1.20 Main Street
NC RI'l I ANt:)OVI-,'.R, N/lASSACI-ItJSE.1-I"S 01845
E-MAIL.: 97&688,9542--FAX
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SEPTIC PLAN SUBMITTAL
FORM RECEIVED
JLJL 2 4 2017
Date of"Submission:--,.�..�.1�7
Site Location•:�-Lot"9MWindkist Farm Road HEALTH DEPARTMENT
Engineer:Christiansen and Sergi, Inc.
New flans? Yes X $275/Plan Cheelc## (includes I"submission and one re-
review only)
Revised Plans?Yes $125/Plan Check 11
Site Evaluation}Norms Included? Yes X No
Local Upgrade Form Included? Yes__.__.__.___.... No X
'rclephone 6,' �t q Q/U .Fax
E-mail: ` P, �� 1 �° fT 41
I-lomeowner
OFFICE USE ONLY
When the submission is complete(including check):
> Date stamp plans and letter
➢ Complete and attach Rcceipt
> Copy File;Forward to Consultant
> V Enter on Log Sheet and Database
Town of North Andover
HEALTH DEPARTMENT
ps�ACNus
CHECK 4: DATE:
LOCATION:Z,.2:L_C
H/O NAME:
CONTRACTOR NAME: r )
AME:(")/ 4`5
Type o¢-permit or License: (Check box)
El Animal
EJ Body Art Establishment
* Body Art Practitioner
* Dumpster
[J Food Service- Type:_
* Funeral Directors
* Massage Establishment
IJ Massage Practice
0 Offal(Septic)Hauler
0 Recreational Camp
0 Sun tanning
0 Swimming Pool
0 Tobacco
0 TraslVSolid Waste Hauler
U Well Construction
SEPnCSys�mn_s.'
0 Septic-Soil Testing lkr�5
Septic-Design Approval $
EJ Septic Disposal Works Construction(DW0
0 Septic Disposal Works installers(DWI)
0 Title 5 Inspector
El Title 5 Report
El Other. (Indicate)-
&,arl Agent Initials
White-Applicant Yellow-Health Pink-Treasurer