HomeMy WebLinkAboutPlans - 87 FOSTER STREET 7/16/2018 TOWN OF NORTH ANDOVER
Community & Economic Development
HEALTH DEPARTMENT
120 Main Street
NORTH ANDOVER, MASSACHUSETTS 01845
978.688.9540—Phone
978.688.9542_.FAX
E-MAIL:healthdept@northandoverma.gov
WEBSITE: hqp-/./Ww)K.noi°thandoven-na.gov
SEPTIC PLAN SUBMITTAL
FORM
Date of Submission:
Site Location:
Engineer: , .s ".�: �, ,,V
I
New Plans? Yes_ $275/Plan Check# s 7 ' (includes 1" submission and one re-
review only)
Revised Plans?Yes $125/Plan Check# �
Site Evaluation Farms Included? Yes No
Local Upgrade Form.Included? Yes No
cj } 1 ,�� Fax#: 7 4/ u .
Telephone#€: _ _.. ._._ � � � �
E-mail: < �,
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Homeowner .
Name:-- ._
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OFFICE USE ONLY
When the session is complete (including check):
Date stamp plans and letter
m , Complete and attach Receipt
rd Copy File; Forward to Consultant
➢ � rx Enter on Lag Sheet and Database
Town of North Andover
HEALTH DEPARTMENT
'I"SACHUS
CHECK DATE:
LOCATION:
CONI'RACTOR NAME:
1yP—eQfU"ernift(m Ucense: (Check box)
0 Animal
0 Body Art Establishment
0 Body Art Practitioner
0 Dempster
Cl Food Set-vice-, Fylje:----
0 Funeral Directors
El Massage Establishment
0 Massage Practice
0 Offal(Septic)Hauler
0 Recreational Camp,
0 Sun tanning
0 Swimming Pool
13 Tobacco
El Trash/Solid Waste Hauler
0 Well Construction
SEPTIC S tetras:
0 Septic-Soil Testing
Septic-Design Approval
0 Septic Disposal Works Construction(DWC)
13 Septic Disposal Works Installers(DM) $
Cl Title 5 Inspector $
El Title 5 Report
0 Other:(Indicate)-- $
HealOrAgent Initials
White-.Applicant —Yellow-Health Pink- Treasurer
4
Town of North Andover
HEALTH DEPARTMENT
CHECK DATE:
LOCATION:
H/O NAME:
CONTRACTOR NAME:
Type of Permit or License: (Check box)
0 Animal
• Body Art Establishment
• Body Art Practitioner
0 Dumpster
0 Food Service-
0 Funeral Directors
• Massage Establishment
• Massage Practice
El offal(Septic)Hauler ,
• Recreational Camp
• Sun tanning
• Swimming Pool
[I Tobacco
0 TrasIVSolid Waste Hauler
0 Well Construction
SEPTIC Systems:
0 Septic-Soil Testing
Septic-Design Approva I
❑ Septic Disposal Works Construction(DWC)
* Septic Disposal Works.installers(DWI)
* Title 5 Inspector
0 Title 5 Report
0 other. (Indicate). -----
Hea -Agent Initialsl
1 1
White-Applicant Yellow-Health Pink®Treasurer