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Home My WebLink AboutHealth Permit # 11/20/2006 Commonwealth of Massachusetts Map-Block-Lot 107.B-0052- Board of Health Permit No North Andover BHP-2006-0739 P.1. FEE S� swt�� F.L $250.00 Disposal Works Construction Permit Permission is hereby granted Todd Bateson to(Repair)an Individual Sewage Disposal System. at No 31 GRAY STREET as shown on the application for Disposal Works Construction Permit No. BHP-2006-073 Dated November 20,2006 iMO.", Bo1 Issued On:Nov-20-2006 tof i r Commonwealth of Massachusetts Map-Block-Lot 1073-0052- Board of Health North Andover . .... . .. Certificate of.�or pliance THIS IS TO CERTIFY,That the-Individual Sewage Disposal System (Repair) by Todd Bateson i Installer at No 31 GRAY STREET has been installed in accordance with the provisions of TITLE 5 of the State Environmental Code as described in the application for Disposal Works Construction Permit No. BHP-2006-073 Dated November 20,_2006 Printed On: Apr-18-2007 Board of Health Map-Block-Lot Commonwealth of Massachusetts 1073-0052- Board of Health Per,nitNo i North orth Andover " FEE s C � $250.00 Disposal Works Construction Permit Permission is hereby granted Todd Bateson to(Repair)an Individual Sewage Disposal System. at Na 31 GRAY STREET as shown on the application for Disposal Works Construction Permit No. BHP-2006-073 Dated November 20,2006 Issued On:Nov-20-2006 Board of Health d 4 A21Aqatior ' r 1. l D ° TODAY'S DATA= Construction Permit - TOWN Or-, a , a a O -26.°00 Component ° °� .•.�'.,. ' g Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use 2.6pair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component cursor-do not use the return key. A. Facility Information �1 �. ^ n r� Address or l_ot# rnrn City/Town— _ ---- 2.® *TYPE OF SEPTIC SYSTEW: ❑ Pump 016ravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiff user(Gravel-Less)(Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box)(Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present)S.A.S. 2. Owner Information - Name ----- -- Address(if different from above) - -- -ow - - W - City/Town e State —_ � �w � Zip Cod�� p Telephone Number 3. Installer Information -- , . _� — - Name Name �. .., OATMbN Address - y At"64 ovc,f, I�� C 9<. d --- — City/Town State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit°Page 1 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: r 1.;t (Address of septic s ystein � For plans b tA.0�u 1' �� amp. p 3 ) p 5 t „ (Engineer) Relative to the application of (hxstalle �s ua ne) i And dated i7gmna ate Dated 1 ""7 1 .� r oc a,s ate With revisions dated (Last revised date) I understand the following obligations for management of this project: 1. As the installer, I am obligated to obtain all permits and Board of Health approved plans prior to perfornvng any work on a site. I must have the approved plans and the permit on Site when any work is being done. 2. As the installer, I must call for any and all inspections. If homeowner, contractor,project manager, or any other person not associated with my company schedules an inspection and the system is not ready, then item three shall be applicable. 3. As the installer, I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection,without completion of the items in accordance with Title 5 and the Board of Health Regulations may result in a $50.00 fine being levied against the and/or my company, a. Bottom of Bed—Generally, this is the first"(V inspection unless there is a retaining wall, which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: healthdept t ttownofnorthandover.com) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must be present for this inspection. With a pump system, all electrical work must be ready and able to cause pump to work and alarm to function. c. Final Grade—Installer must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only I may perform the work (other that siwple excawlim)and I am required to complete the installation of the system identified in the attached application for installation. I further understand that work done by others unlicensed to install septic systems in North Andover can constitute reasons for denial of the system and/or revocation or suspension of my license to operate in the Town of North Andover, significant fines to all persons involved are also possible 5. As the installer, I understand that I must be on-site during the performance of the following construction steps: a. Determination that the proper elevation of the excavation has been reached. b. Inspection of the sand and stone to be used c. Final inspection by Board of Health staff or consultant. d Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other components. 6. As the installer, I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner,general contractor, or any other persons shall absolve me of this obligation, Undersigned Licensed Septic Installer: µ t (Today's Date) ame—Print) atrie— ignc