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Home My WebLink AboutHealth Permit # 11/10/2005 ;` Comrnofi wealth of Massachusetts Map-Bbek-Lot 77 106.A-0160- I Board of Health -- Pennit No - 5-0713 NOrth BHP-200 PI f " rw�.ate r rf FEE F ,' r,, � $250.00 ' Dasposal'V4/ C ,t n�rP�� orks onstruc �o errnit wyna, met Pernussion zs hezeby granted john SOUey � ,� � ,F ,�'�� " �" 2b(Repair)an Individual".Sewage Dls�osal System �,��f �,��'' s, l r'��,' , h r - as-shown on the application for Disposal Works Construction PemutNo BHP"2005 0/1� Dated November 10,2005 - ' Issued On 6V-;10 2005r�� - ..,.... . ,.. .. : . .. 9 fHealth o a �.u...�. . rl i ! ,ep,v IiC ti iC I r` ,❑ <. m TODAY'S ATE � r�S r�Ctl n Permit — TOWN OF n "' V �(,� �Qt Full Repair " ,r«". ANDOVER, 125.00 - Component 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 Repair 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 / ( a Information ;: (74 eb Address or Lot# erwn City/Town 2.- *TYPE OF SEPTIC SYSTEM : ❑ Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(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) City/Town State Zip Code Telephone Number 3. Installer Information Name Name of Compa Addres City/Town State Zip od .._... ._.—..._- 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 o� t%ORTH Application f r tic i al y Construction Permit ® TODAY'S DATE � - w 'I" 50.00-Full Repair �SSacEtius��A� g $125.00 -Component PAG2OF2 A. Facility Information continued.... 5. Type of Buildin : Residential Dwelling or Commercial Vp Ci g ❑ B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site 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 iss d�d by this Board of Health. Name / Date r � Application Approved By;, Board of Health Representative) j Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes " No 2. Project Manager Obligation Form Attached? Yes No 3. Pump S, stem? If so,Attach copy of Electrical Permit Yeses No 4. Foundation As-Built?(new construction ronly): Yes_ No (Same scale as approzed plan) f1� 5. Floor Plans?(new construction only): Yes_ No Application for Disposes'System Construction Permit•Page 2 of 2 INSTALLER PROJECT MANAGEMENT OlBuGATIONS As the North Andover licensed installer for the construction of the septic system for the property atA. `, ...... .. .:m_ C �.. �:�,�, ,' relative to the application of>1"1"� r),.. , p Y .r �' and . � c, for fans b rt dated f ��^� � dated 1 a e5`..with revisions dated I understand the following obligations for management of this project: I. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing 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 manger, 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 Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With 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. Does not have to be on site. 4. As the installer I understand that only I may perform the work (other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work 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. Undersi'gynrd L- used Septic Install , Date: 'w,I Date " t N°oTFi 1H 1 OWN O� 1`iOftTlrl /11�&®O�I�I� ®F2 WI o� a PERMIT F F w SSACAU5 This certifies that. : �'. ion to perform L'�; .. �..... .i. �:y: .,;�.. ✓ .... has perm�ss .. wiring in the building i ass. ,l North Andover M i at Lic.No EicCTRICA► I sre Fee. �...... I r Check # � 3 f ; " r r Official Use Only Commonwealth of Massachusetts IF7 Permit No. Ci r Department of Fire Services ��# [ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 27 CMR 12.00 PLEASE PRINT IN INK OR TYPE ALL INFO P�,tvA,TZON) Date: ��/ City or Town of: C).c-A v To the Inspector of Wires: By this application the undersigned gives notice of his or her inttee`ntion to,perform the electrical work described below. r Location (Street&Number) / `�C ('d�vyv `tee' s P 0- Owner or Tenant Ab 64 Telephone No. Owner's Address Taid/Z Is this permit in conjunction with a building permit? Yes ❑ No ❑'� (Check Appropriate Box) Purpose of Building`;/L/L�t yL i� �i� Utility Authorization No. Existing Service V's. Amps -2 Volts Overhead[�`' Undgrd❑ No. of Meters / New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: //7 y,� Cons letion,o the ollowin table inay be waived by the Inspector of Wires. No. of Total No. of Recessed Fixtures No.of Ceil:-Susp.(Paddle)Fans Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA Above In- o.o mergency Ig In No,, of Lighting Fixtures_ ____, _. Swimming Pool ._rrdc _❑ rr. ❑ ga't�: Ur.it FIRE ALARMS No. o Zones No.of Detection and Initiatin Device No. of Alerting Devi es Date ` ••••....................... No.of Self-Contai ed Detection/Alerti Devices _ Local ❑ Mu cipal ❑ Other NpRTM Co nection o'<<«•°„•-14, TOWN OF NORTH �lNI®OVEF2 Security Sy ems: _ ° : p PERMIT FOR WIRING No.ofevices or Equivalent * — Data Widrg: No.of Devices or Equivalent Wiring: S�cwuSEt No. of Devices or Equivalent This Certifies that detail if desired,or as required by the bispector of{fires. .............. ••��•��• rformance of electrical work may issue unless' has permission to perform .....:.... ..i : ......... coverage or its substantial equivalent. The .................. ne to the permit issuing office. wiring in the building of......................... ........ ;;, North At1dOVer,Mass. (Expiration Date) ................:. .. ........, ... , ucipal policy.) +Fee .. Lie.NO .....:.. ... ............................ ..:..: MEC Rule 10,and upon completion. ELECTRICAL INSPECTOR ipplication is trite and complete. LIC.NO.: rJ i X55'S check # _ -_- -- LIC. /2-- Bus.Tel. No.yZ`2S- 'i I i �G/r s//✓/ i')/ �� Alt.Tel. No,: OWNER'S INSURANCE WAIVER�m aware tat the Licensee does notm e the (lability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent, Owner/Agent PERMIT FEE: $ �P Signature Telephone No.