HomeMy WebLinkAboutSeptic Plan Submittal - Receipt - 326 CAMPBELL ROAD 7/30/2020 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:http://www.northandoverma.gov
SEPTIC
FORM PLAN SUBMITTAL
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Date of Submission:February xx, 2019 pPOE NOR�N '�R
Site Location: 326 Campbell Road
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Engineer: Andover consultants, Inc.
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New Plans? Yes X $275/Plan Check#17414 (includes I"submission and one re-
review only) q
Revised Plans?Yes $125/Plan Check#
Site Evaluation Forms Included? Yes No X
Local Upgrade Form Included? Yes No
Telephone#: 978-687-3828 Fax#:
E-mail:jimfairweather@andoverconsultants.com
Homeowner
Name:Applicant: Carolina Properties, LLC
OFFICE USE ONLY / �'n >J I
T
When the subr i sion is complete (including check): or 51' I O
➢ ✓ Date stamp plans and letter ✓� 1
➢ Complete and attach Receipt G�
➢ �/ Copy File; Forward to Consultant K
➢ V Enter on Log Sheet and Database
Of 4NORTM,� V 5 �
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Town of North Andover
HEALTH DEPARTMENT
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CHECK#: Z DATE:
LOCATION: Xg
H/O NAME: is
CONTRACTOR NAME: i
e 1-p 0,1 6r. n ES
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 $
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1 Septic-Design Approval $ 7 J—
❑ Septic Disposal Works Construction(DWC) $
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
❑ Title 5 Report $
❑ Other:(Indicate). $
Hea gent Initials
White-Applicant Yellow-Health Pink-Treasurer