HomeMy WebLinkAboutSeptic Plan Submittal - Receipt - 137 FOREST STREET 5/14/2019 o TOWN OF NORTH ANDOVER
Community & Economic Development
HEALTH DEPARTMENT
120 Main Street
` QPQ'���N NORTH ANDOVER, MASSACHUSETTS Ol 845
av� ���� 978.688.9540—Phone
978.688.9542—FAX
E-MAIL:healthdept@northandoverma.gov
WEBSITE:http://www.northandoverma.pov
SEPTIC PLAN SUBMITTAL
FORM
Date of Submission: May 14, 2019
Site Location: 137 Forest Street
Engineer: John (Jack)Sullian
New Plans? Yes x $275/Plan Check# (includes 1st submission and one re-
review only)
Revised Plans?Yes $125/Plan Check#
Site Evaluation Forms Included? Yes x No
Local Upgrade Form Included? Yes No n/a
Telephone#: 781-854-8644 Fax#:
E-mail: jacksul153@comcast.net
Homeowner
Name: Bob Moore
OFFICE USE ONLY
When the ssion is complete (including check):
➢ -ftJ Date stamp plans and letter
➢ Complete and attach Receipt
➢ k Copy File; Forward to Consultant
➢ Enter on Log Sheet and Database
Gf MOR7 14 V V �.
Town of North Andover
`�••�,,,,o.: HEALTH DEPARTMENT
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CHECK#: A DATE: .5'
LOCATION: /3 7 _/-o r�.a - 4
H/O NAME: /306 / n0
CONTRACTOR NAME: Zcx� 5-y/�i/o-/)
T_ype of Permit or License: (Check box)
❑ Animal $
❑ Body Art Establishment $
❑ Body Art Practitioner $
❑ Dumpster $
❑ Food Service-Type: $
❑ Funeral Directors $
❑ Massage Establishment $
❑ Massage Practice $
❑ Offal(Septic)Hauler $
❑ Recreational Camp $
❑ Sun tanning $
❑ Swimming Pool $
❑ Tobacco $
❑ Trash/Solid Waste Hauler $
❑ Well Construction $
SEPTIC Systems:
❑ Septic-Soil Testing $
} Septic-Design Approva l —
❑ Septic Disposal Works Construction(DWC) $
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
❑ Title 5 Report $
❑ Other:(Indicate)--.-
iieiak Agent Initials
White-Applicant Yellow-Health Pink-Treasurer