HomeMy WebLinkAboutHealth Permit # 10/26/2012 ° 7�S,L '��. Commonwealth of Massachusetts Map-Block-Lot
BOARD OF HEALTH 106.D0069
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Permit No
North Andover BHP-2012-0753
FEE
$125.00
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I
DISPOSAL K CONSTRUCTION I1"
Permission is hereby granted Todd Bateson
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to(Repair)an Individual Sewage Disposal System. ;�-' h
at No 90 WINDSOR LANE 16ov- I ' a n L
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as shown on the application for Disposal Works Construction Permit No. BHP-2012-075 Dated October 26 2012
Issued On: Oct-26-2012 ------------------------------
------------------ -------------- BOARD OF HEALTH
��' I"+b&P"u`hR poi �' I � �I I � ✓�' ..,,f .». q ®..
TODAY'S DATE
Construction Permit - TOWN OF
. � 1 ? 00-�Full Repair
'-Component
12
Important: Application is hereby made for a taermit 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 M�pair or replace an existing system component—What? °�"� �a®Y, ,�' t "''e'
cursor-do not
use the return A. Facility Information
key.
i ah Address or Lot#
. tr
-- --- --- ---
------ --- - ----- --
n d City/Town jh_
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 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
VkJ Name -- - - ------ --- --
6^a .
Address(if different from above)
City/Town State Zip Code
Telephone Number
3. Installer Information
Name
— Name of Co mpany I11 ARGILLA ROAD
Address
k'4"ba
City/Town State Zip Code
Telephone Number(Cell Phone#if possible please)
4. De I ner 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
�oRTN AoPlicati-on..for Septic Disposal :System
c s,�..,,�tio
3-1 .:,� ,�.;• oc TODAY'S DATE
p Construction Permit = TOWN OF
* ° •f �ORTH .AND OVER, MA 01845 $.250.00-Full Repair
$125.00,-Component
,SSICNUSE
PAGE 2 OF 2
A, Facility.lnformatio.n continued....
5. Type-of Building: ®Residential Dwelling or ECommercial
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 Issu ,t y this Board of Health.
Name Date
Applicati ItfApproved By:fQoard of Health Representative)
Na a Date
Application Disc proved.Ue following reasons:
For Office Use Only:
1 Fee Amched?: Yes_ No
2,. Projectltlariager Ohlrgation Form Attached. Yco No
3, Pump_System? Ifsot Attach copy ofElectrical Permrt:.. Yeo No
4 Foundation As Built.?(new construction•ronly); Yes_ No
(Same scale as approved plan)
tr
5, F1oorPlans?(new construction only); Yes_ No
Appl(cation for•pispgsal ysterii-:0onstruction Penn�Page 2 Of 2
SEP'k'IC S.Y.STEM.INSTALLEg•PROJECT NIAi�TAGEl�'IENT 'oBLIGA'I'IONS
As Ehe North Andover-licensed uistaller for the consttuetioi�for:the septic system%for.the property at:
For plans by
(Address of septic system) (En 'lee
Relative to the.application of - And dated
(in'staller's name) -----�Qrigm ate .
Dated With revisions dated
o a s date.) (Last revised ate)
I understand the following obligations for management of-this pxoject:
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 must have the aptro;red_plans and the permit on site when any work is
b'ein_g done.
2. As fhe installer,•Imust can for.any and atlinspe' bons: 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.
As.the installer;I'ata'.r•equired to.have.tire necessary work•Onmpleted•prioi`;to the.applicable inspections as
indicated below I titrdefstand that reciue'stin�an inspection without comtiletiorl:of the items in accordance
with Title 5 and the tb of Health ons•ti7ay,tesull in a$50 00 fide beln�.levted agatnst me..and/or
ati Bo'tto'm if.•B.ed Genexall ,this is the fitst,1' ecdon-pnless.there is a�retainin wall,which
should-be dpi ie first 'Tlie°nistalf must equest 1fie inspection but tides riot have to be present. .
b. Final Construatori.Inspection—Engineermust'firs ;do theiriitspect'ion for elevations;ties,'etc.
As-built of•�.erbal OK*(or e-mail-to:health ' ct townofnorthando*.- 4. gm)from the engineer must
be stibtriitfed to.the Board-of Health,.aftex•.�vhich::installer.ca31$fgr.an inspection time. Installer must
be present for this•inspection, With-a pump system;all electrical woik;must be ready and able to
cause p=p.to*ork sirid•olarm-i6 funetion..
C. :Final Gtacle installer must:request inspection tvhch grading is complete._..Installer dow not
have to be on-site.
4. As-the installer,'I understand that only I tuy p0ibrm the work•(other than:rimple excavation)and I am-required
to complete th&insta'llation of the system identified in.the attached application for installation:'.I filxtlier
understand:that work done'l others uiiii'censed-''t o,instalf septic systems•in North Andover can constitute
reasons for denial of the system and/or".revocatiori•or suspension of.my lice'nse:to operate in.the Town.af
North Andover 'sificant fines to all perso'ns iri'volvetl:are alto pflssible.
5.. As tlie:installer,,I understand that'l m'ust`be•on site during theperOxmance.of the following construction.
steps:
a: Deternunatioa Ethat.the proper elevation of the excavratron has been reached -
A Inspection of the sand and stone-to be used.
c. Final kspectiorr by Board ofHealth staff or consultant.
d. Ins don,of D-Box.pipes,stone, vent,primp chamber,retains wall and other
components.
6. As th2 stiller I•understand that ham sole*responsible for the installation of the system as per the
appro'vedd lans No instructions by fhe�homeow er,generaf.contra6tor -or•any otlier•persons shall absolve
me pf this obligation. :
Undersigned Licensed Septic.fin. .allex: ` (Z'oday''s Date) ��`
L4 OR