HomeMy WebLinkAboutSeptic Plan Submittal Form - Receipt - 130 REA STREET 9/17/2019 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
northandoverma.gov
WEBSITE:h!W://www.northandoverma.gov
SEPTIC PLAN SUBMITTAL
FORM
Date of Submission:9/16/19
Site Location: 130 Rea Street
Engineer:Benjamin C. Osgood, Jr.
New Plans? Yes X $275/Plan Check# (includes I" submission and one re-
review only)
Revised Plans?Yes $125/Plan Check#
Site Evaluation Forms Included? Yes X No
Local Upgrade Form Included? Yes X No
Telephone#:978-435-1324 Fax#:N/A
E-mail:bosgoodpe@gmail.com
Homeowner
Name: Rob ert Woodcock
e
OFFICE USE ONLY
When the sub sion is complete (including check): NpFttH NS ENS
1�\�I�A� O�pP��➢ Date stamp plans and letter 10M
➢ Complete and attach Receipt
➢ ��`Copy File; Forward to Consultant
➢ i/ Enter on Log Sheet-andBatabase
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O, NORTq,y �
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r Town of North Andover
e:: �' HEALTH DEPARTMENT
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CHECK#: /� DATE: / 7
LOCATION: 1,30 &C,
H/O NAME: 4-o ocoLock
CONTRACTOR NAME: A4 0,
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 $
i
❑ Tobacco $
{
❑ TrasWSolid Waste Hauler $
❑ Well Construction $
SEPTIC Systems:
❑ Septic-Soil Testing $
/ Septic-Design Approval $�.�S•�
❑ Septic Disposal Works Construction(DWC) $
❑ Septic Disposal Works Installers(DWI) $
❑ Title 5 Inspector $
1
❑ Title 5 Report $
I
❑ Other. (Indicate)
`kealth Agent Initials
White-Applicant Yellow-Health Pink- Treasurer