HomeMy WebLinkAboutSeptic Plan Submittal Form - Receipt - 101 FOSTER STREET 7/28/2020 I
TOWN OF NORTH ANDOVER
Community & Economic Development
HEALTH DEPARTMENT
1.20 Main Street
NOR.TI1 ANDOVER,MASSACHUSETT°S 01845
97&688.9540-Phone
9 $.6'88.95.42-FAX
E-MAIL. healthdept@noa-thandovern a.gov
'vVRDSITE:, tt ,//www.northandoverm . ov
SEPTIC PLAID SUBMITTAL,
FORM
Date of Submission,7127/2020
Site Location: 101 Foster street
Engineer:Benlarn'rn Gsgoad J'r.,
New Plans? Yes X _ 275/Plan Check 4 (includes I"submission and one re-
review only)
Revised flans?Yes_.m. ._ I25/1'lan Check
Site Evaluation.F'onns Included? Yes X No
Local Upgrade horn Included? Yes No N/A
Telephone ;978-43 -1324 Fax :N/A
E-mail: Bosgood rang r ng,co
Homeowner
Name:Kenneth Grasso
i
OFFICE USE ONLY
When the fission is complete(including check):
Date stamp plans and letter
Complete and attach Receipt
�
Copy% Co File F"ot-ward.to Consultant
Enter on Log Sheet and Database
f
Town -f North Andover
HEALTH DEPARTMENT'
CHECK #: DATE:
LOCATION:
H/O NAME:
"4
CONTRACTOR NAME: '
'!M�Lqf j!grynit or License: (Check box)
0 Aninial $
0 Body Art Establishment $
0 Body Art Practitioner $
0 Dumpster
0 Food Service-
0 Funeral Directors $
0 Massage Establishment $____
0 Nlassage.Practice $
• Offal(Septic)fla tiler
• Recreational Camp
0 Sun tanning
0 Swimming Pool
0 Tobacco
0 TrashlSolid Waste Rattler $
FJ Well Construction
LEP11C Metres:
0 Septic-Soil Testing $
Septic--Design Approva I
Septic Disposal Works Construction(DW0
0 Septic Disposal Works Installers(DW[) $
0 Title,5 Inspector
0 Title 5 Report $
0 Other:(Indicate)---.--- $
Hea IWAgent Initials
j�jtite-Applicant Yellow-,Health Pxnk-Treasurer