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HomeMy WebLinkAboutHealth Permit # 5/5/2015 Commonwealth of Massachusetts Map-Block-Lot 106.001 12 BOARD OF HEALTH -Permit-1 No------------ North Andover -BHP-2015-0160---- FEE $250.00 ----------------- DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted Bateson-Ent---------------------------------------- ---------------------------- ------------------------- ------------- ------ to(Construct)an Individual Sewage Disposal System. at No 296 RALEIGH TAVERN LANE 0& ----I------- ------------------ ------I---------- --------- --------------- --------- ------ -------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BELP-2015-016 Dated May 05,2015 - ----------------- - --------------------------------- -------------------------------- Issued On:May-05-2015 BOARD OF HEALTH ------------------------- I i r i 1 i �... -. : ...._. . Construction Permit - TOWN OF TODAY'S DATE NORTH ANDOVER, MA 01845 2501.00'—Full Repair $125.00®Component Important: Application is hereby made for a oermit to: When filling out ❑Construct a new on-site sewage disposal system* forms on the computer,use epair or replace an existing on-site sewage disposal system* only the tab key to move your ❑Repair or replace an existing system component—What? cursor-do not use the return . Facility Information ey Address or Lot# City/Town MAY 0 !') ��,���'� 2.-*TYPE OF SEPTIC SYSTEW: i �� NOR Fig ANDOVER ➢ [afPump ❑Gravity(choose one) HEALTH VN O tiER 111�t"!Fi[::�PJ"f —*If pump system, attach copy of electrical permit to application*** > ❑Conventional System (pipe and stone system) A EFthfiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to install this type of system.) ➢ ❑Pressure Distribution S.A.S.(No D-Box) ➢ ❑Pressure Dosed(D-Box Present)S.A.S. ➢ ❑ Does the system require an effluent filter? Yes V" No If yes, does plan specify make and model of filter? lY - (no further info, needed) NO®(installer must specify brand of filter before DWG issuance) What is the Maker What is the Macke' 2. Owner Information Name Address(if different from above) µ Cityrrown State Zip Code � tr�,✓ c: 4'„�" .,_�l 1,�.�s Telephone Number 3. Installer Information Name Name of Company Address p Cityrrown State Zip Code ez' 'r -)6__. Telephone Number(Cell Phone#if possible please) 4. Designer Information py Ide, P j i . (.lW+A.,Mi-4u-1„ L+/`fi `1_ [ "y 4'• P f XF.stn Name ' Name of Company 5.. " Address --- -- CityiTown State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 a�RVN Op,, ..,e�tio -- ---II Vii' .• r ti ,i : . I t s' .. ��.. � �.._.. 1 °+ . ® o TODAY'S DATE . n tr t� •. . r it . $.25D.00".Full Repair CHO $125.00,-Component PAGE 2 P A. acility.lnf®rrnatiort continued.... 5. Ty ►w of uildinct, K•Idential Dwelling or 00ommerciai B. Agreement The underslgned agrees to ensure the construction and maintenance of the afore-described on-slte sewage disposal system In accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system In operation until a Certificate of Compliance has been Issued b this Board of Health. Name ✓ .a M �. Date Aloplic e>ion A pp r �Od of Health Representative) � (��a d 4N me Date Application M§approved,for the following reasons: For Office Use Oniv° I. ''Fee Attacheda Yes _ No 2;• Pro ectAfaba g"et Oblr` r� orzn 1.. ad: .w 1 '.,_ ' Yes 31: Pum ? If f E'ler¢rlrcal Pernart Yes l Na 4. F,a,.y m•�w_.q_St"o rA s-BW7tR, cons tu.0. ion..r. or ... . Ys-_... ..... .. ._ .w Noame scale as appO'c ved t �) m 5 .Floor Plans,(new construction-only); yes Applrc N©n Tor C7lsposai 5ysterit:06rtstructloh Permit%Page 2 of 2 ` As eN rtb ,. die �� e' c'O�-f�."` hd septic s ,•fopx p (Ad araepdc aqa ) a-Adr plans by lative to tht's fCation Of (fb" llra s tste) 1bd dated .�.� J Dawl ..gym ��,,......�.:� ae. a With moss dated (zaat revised deta) undestad the following Obligadom for nufta,gament Of 0b 1. a the sastw I ,cab tad t**6btdm PI p lts and Bbaard Illith approved plam pft to peso any"Work Cia it site: I M= that � , a e a.r cft a� � a� works 2. si ' �, txat for mdAlm other,ptmota rlet ago with �e ra ctcttr.pxojeet ,or any i $ bo.St•p.p. bla. F eoassp' iu as ,0, and the spa ttin is not tudy,th+ jj the,9pp]k*bje a+ s o as wA wtich shu�d+bi;46ri" #Pit ecdOA but dtiies•rlot have to be prescir 31c c+f �►ezb I k'(Or a : , -be d,tcjha, mv. •ofd from the " eO must a eti�v fOVan Inapell time •l#tatdller"t be present far , ' filiTeedtin, Wkh as p; `13 qttg ?vat`be tem4y atsd able to. cauM P.Onv•towork d ;to . . C. a ermustaquegop 04 tnla ! have to lyefsi pltto.' Iastallet il0as not 4. ATtheh1U 'I d dut only I p' rhos` '(Mh#rtti i " o' R � mplere i of the Iax ti }teal I o 'a °)gad ate r ad ixis ttan: 4 P 5.. ;,pit the,�at�llar, �v�iid � tl:�xraa '�t'cc�s�t�� �•uf tb� ' ' . • stap�a: th 'p• fours COUStx�C61m• met' ���� �tf. � eP ` +� '•bc tse�v�a�I ' andsodhe tai 8e usedH ° pe �J' v od` + fh tar ctrl t, 1PYPOa 4s -�i. P Ofift&er, x other COMP4000O. 6 ' P MOD