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HomeMy WebLinkAboutSeptic Plan Submittal - Receipt - 487 WINTER STREET 8/30/2019 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:hM://www.northandoverma.g_ov SEPTIC PLAN SUBMITTAL FORM Date of Submission: �j "�� o�O/ 9 Site Location: �� 7 ///� Te/' S 7 Engineer: 70 Se /7 New Plans? Yes_y/ $275/Plan Check# 7.2a8 (includes 1st submission and one re- review only)Revised Plans?Yes `/r $125/Plan Check# Site Evaluation Forms Included? Yes No Local Upgrade Form Included? Yes No X Telephone#: 9 8 ' S Fax#: E-mail: Homeowner Name OFFICE USE ONLY When the submission is complete (including check): ➢ Date stamp plans and letter ➢ Complete and attach Receipt ➢ _Copy File; Forward to Consultant ➢ �Enter on Log Sheet and Database i 8646 f MORTH O •- w A ,may Town of North Andover HEALTH DEPARTMENT s1CNU5t CHECK#: 2-L"'K DATE: k -Ll ILI LOCATION: LA t' - S+- H/O NAME: , +„ CONTRACTOR NAME: \c),r Snoa�t�� 1 Type of Permit or License: (Check box) ❑ Animal $ 0 ❑ 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 Approval ❑ Septic Disposal Works Construction(DWC) ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ i ❑ Title 5 Report $ j ❑ Other:(Indicate) $ Flet#lth: t Initials White-Applicant Yellow-Health Pink- Treasurer fp Of o 9 Town of North Andover '+ HEALTH DEPARTMENT �SS�cHustt CHECK#:7a 6 DATE: 7- 9-�O LOCATION: y8 n j H/O NAME: l cu a- CONTRACTOR NAME: i Type 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 fl, Septic-Design Approval Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other:(Indicate) $ Itea Agent Initials White-Applicant Yellow-Health Pink- Treasurer