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HomeMy WebLinkAboutPlans - 49 WINDSOR LANE 5/14/2014 1If « 1 TOWN F rgORTI VE Office tti t_;t 1" 1J'MTV Dl+e l'.LtlPMEA"AND SERVICES 600 OfleGt` OD S ittlP E i`; SUITE 2035 N(.?R."riI ANDOVER, MASSACHLAETTS 01845 978.688.9540 Phone Susan 1'.Sawyer,REHS/RS 978MU476- FAX Public Health Director E-MAIL: he alt-1, dover.com: �cr...... M,ay�7u SEPTIC PLAN SUBMITTAL FORM Date of Submission: Site Location: Engineer: New Plans? Yes $225/Plan Check# �" � (includes Ist ubrn e- review only) MAY 15 2014 Revised Plans?Yes $75/Plan Check# Ct,V F of rya ANDOVER, 'rH DE E Site Evaluation Forms Included? Yes_sz No TMF- Local Upgrade Form Included? 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Q? m n 4V c =r O r« 0 o�i 4 ? � � o (1) v n� _L Q c tU to �_ �) m - ro CLo 0 0 v CL ;. 0 �. p ((DD 0 cu o (D CD $ (D N (D p� Q Q 7j. C) r m rn U� (OD V v 2. 0)O O 7 O ='+ < CL O Q. Q C -ox 2 CD M ro n m cn j p J -n (7 — (D Q o i Commonwealth of Massachusetts t City/Town of Percolation Test Form 1 M Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with the local Board of Health to determine the form they use. Important: A. Site Information When filling out �r forms on the Kit" computer,use only the tab key Owner Name to move your Al 1 ( � cursor-do not Street Address or Lot# 1 use key,the return O / I t `m" A. Gity/Town State Zip Code Contact Person(if different from Owner) lep one Number B. Test Results Date Time Date Time Observation Hole# Depth of Perc Start Pre-Soak IQ : 1 End Pre-Soak , ( 1 Time at 12" r1 0 Time at 9.. I I Time at 6" I Time (9"-6") Rate (Min./Inch) Test Passed: Test Passed: ❑ Test Failed: ❑ Test Failed: ❑ Buz Aw/ z Test Performed By: Witnessed By: Comments: t5form12.doc•06/03 Perc Test-Page 1 of 1