HomeMy WebLinkAboutHealth Permit # 6/9/2011 Commonwealth of Massachusetts Map-Block-Lot
�kQ 107.A0064
BOARD OF HEALTH Permit No
BHP-2011-0717
North Andover -----------------------
y� P.I. FEE
F.I.
$250.00
DISPOSAL WORKS CONSTRUCTION IT
Permission is hereby granted James-Kellett
to(Repair)an Individual Sewage Disposal System.
at No --19-0-MILL-ROAD
as shown on the application for Disposal Works Construction Permit No_.BHP72011-071 Dated June 09,2011
------------------------ -----------------------
1;�--- -------- --
Issued On:Jun-09-2011
s h d l BOAR D"OP",HEALTH
C.
µ Application r tB I u V m June 2,2011
TODAY'S DATE
Construction Permit - TOWN OF
,��. . �..�.z5a as m Full �e�_Jr
0145 �1 .a = ;pin ,t
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—what?
cursor-do not
key the return A. Facility Information
y , .
190 Mill Road
� Address or Lot# l
North Andover, MA „ l
r
City/Town
t r
2.m*TYPE OF SEPTIC SYSTEM*:
9 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
John Moglia
Name
190 Mill Road
Address(if different from above)
North Andover MA
City/Town State Zip Code
617-620-9004
Telephone Number
3. Installer Information
James Kellett Kellett Excavating, LLC
Name Name of Company
400 Salem Street
Address
Lynnfield MA 01940
City/Town State Zip Code
781-599-7934
Telephone Number(Cell Phone#if possible please)
4. Designer Information
James Scanlan Scanlan Engineering _
Name Name of Company
PO Box 906
Address
Georgetown MA 01833
l W f r �❑,
I "x�
City/Town State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit•Page 1 of 2
�o to on for Septic Diapp5all S June 2, 2011
n tructi n Permit TOWN TODAY'S DATE
tl T 1 $250.00®Full Repair
$125.00-Component
PAGE 2 OF 2
A. Facility Information continued....
5. Type of uildlnct: ❑Residential Dwelling or❑Commercial
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 issued by this Board of Health.
James Kellett June 2, 2011
Name Date
r
Appli �finApprove y: (Board of Health Representative)
Na e " Date
A plication Disapproved for the following reasons:
For Office Use Only:
1. Fee Attached. Yes No
2. Pr o&ct anager Obligation Form Attached? Yes ° No
3. amp System If so,Attach cony of Electrical Permit Yes No %- -
4. Foundatton
As-Built?(new construction r®nly):- Na
(Same scale as approved plan) °
9. Floor Plans?(new construction only): r �e� No
Application for Disposal System Construction Permit•Page 2 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:
1Q0 Nfill Road
(address of septic system) For plans by James(Address
(l:rtp;intwes)
Relative to the application of James Kellett
(,".Installer's name( And dated October 7,2010
° ngina date)
Dated June 2,2011
o ay s ate) With revisions dated October 26, 2010
J'ast 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
performing any work on a site. I trust 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 me and/or
my company
a. Bottom of Bed—Generally, this is the first (1'� 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 C7I< (or e-mail to: its althtl.cpi>,tca\vtuo falcalt.fr�cle>v„twY°.cct1) from the engineer must
be submitted to the Board of Health, after which installer calls for an inspection time. Installer trust
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 trust 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 than sirreple excamliofz) and I atn 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 fallowing 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-,'Health staff or consultant.
d. Installation of tank, D-Box,pipes, stone, vent,pump chamber, retaining wall and other
components.
6. As the installer, understand that I am solely responsible for the installation of the system as per the
approved plans Na instructions by the homeowner, general contractor,or any other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: June, 2 2011 (l°a.rday's Date)
�atnes R., Kellett
tsttc riot
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10125
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°•t""�";,"o TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
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