HomeMy WebLinkAboutMiscellaneous - 60 DEER MEADOW ROAD 6/20/2018 TOWN OF NORThI ANDOVER
, . 2 2011 Community& 14,crznomic Development
ANHEALTH DEPARTMENT
NT
TOWN�N OF NORTHNORTHS' 120 Main Street
ALTH DEPARTI NT
NC WFIJ ANDOVER,MASSACI-IUSETTS 01845
97808.9540 Phone
978.688.9542--FAX
E-MAIL.: healtlidept@iiorthandoveinia.gov
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SEPTIC PLAN SUBMITTAL
FORM RECEIVED
Date of Submission:September 12, 2017 SEP 1 017
TOWN OF NORTH ANDOVER
Site Location:60 Deer Meadow Road, 104.B/118 HEALTH DEPARTMENT
Engineer:Greg J, Hochmuth, RS#1213
New Plans? Yes X $275/Plan Check # (includes I" submission and one re-
review only)
Revised Plans?Ycs $125/Plan. Check#
Site Evaluation Forms Included? Yes X No
Local Upgrade Form Included? Yes X No_......_.__.
'Telephone#:978-539-8088 Fax#:978-539-8200 — --
E-mail:ghochmuth@wsengineers.com
Homeowner
Name:Sumeeta&Sunit Mukherjee
OFFICE USE ONLY
When the submission is complete(including check):
➢ Date stamp plans and letter
xm
Complete and attach Receipt
> ile;Forward to Consultant
Copy F
V/ Enter on Log Sheet and Database 1
1
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Town of North Andover
41 HEALTH DEPARTMENT
CHU1.
C H E K
L/35 DATE
LOCATION:
ey
H/O NAME:
CONTRACTOR NAME, ."'Ll/l/aw.11�1�1 �,v&/
lype of Permit or License: (Check, box)
• Animal
• Body Art Establishment $
• Body Art Practitioner
0 Dumpster
0 Food Service-Type:---
0 Funeral Directors $—--------
EJ 'Massage Establishment
• Massage Practice
• Offal(Septic)Hauler
0 Recreational Camp
• Suit tanning
• Swimming Pool
0 Tobacco
0 TrashlSolid Waste Hauler
0 Well Construction
SEPTIC Systems:
0 Septic-Soil Testing
XSeptic--Design Approval $-IJ
* Septic Disposal Works Construction(DWQ $—
* Septic Disposal Works Installers(DWI) $
* Title 5 Inspector
0 Title 5 Report
0 Other. (Indicate)
6
Heafil h%�Ag'ent Initials
White-Applicant Yellow--Health Pink- Treasurer