HomeMy WebLinkAboutHealth Permit # 5/3/2004 .......................................................................
Commonwealth of Massachusetts Map-Block-Lot
104.B 0 1 2 9-
Bo rd Of Health Permit I No
BHP-2004-0364
North Andover - - - I'll I
P.I. FEE
F.I. $250.00
Disposal Works Construction Permit
Permission is hereby granted Ro,cci1,De,Lucia,,Jr.
to(Repair)an Individual Sewage Disposal System.
at No 178 STONECLEAVE ROAD
as shown on the application for Disposal Works Construction Permit No. BBP-2004-036 Dated December 12,2003
Issued On: May-03-2004 BC Ith
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Map-Block-Lot
Commonwealth of Massachusetts 104B-0129-
Board OfHealth
North Andover ...............
Certificat""f
711I 1,5 the lndividua,�6,w
IS 1,5 TO CE "age'llisposal System (Repair)
by Rocci DeLucia,Jr.
Installer
at No 178 STONECLEAYE-ROXD
has been installed inaoc6i'dance with the provisions of TITLE 5 of the rDii State Environniental as described in the
S �Ilvi
applicationjoposal Works Construction Permit No. BHP-2004-036 Dated December 1 2003
Printed On May-03-21004 "Board Of Health
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104,B-01129- SC
Permit No
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issued May-03-2004
Board Of Health
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APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE:_ CURRENT INSTALLER'S LICENSE#
LOCATION:
ell
LICENSED INSTA E r
SIGNATURE:-, 0 TELEPHONE#
CHECK ONE:
REPAIR:— L.,/ NEW CONSTRUCTION:
sok
IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
ZO Administrative Use Only
, 00 Fee Attached'? Yes---- No
Foundation As-built? Yes_
Floor plans on file"?
Yes No
Approval 4
Date:
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the
at---
` -
5 relative to the application
property
� wo �.�. A dated ...w_ �� for plans by � or'Y� ua �w�wtn`lr and
of ✓ ' __ f "is
dated °� � with revisions dated
I understand the following obligations for management of this project:
1. As the installer I am obligated to call for any and all inspections. If homeowner, contracto
project manger, or any other person not associated with my company schedules an inspectio
and the system is not ready then item two shall be applicable.
2. As the installer I am required to have the necessary work completed prior to the applicabl
inspections as indicated below. I understand that requesting an inspection,. withou
completion of the items in accordance with Tile 5 and the Board of Health Regulations ma;
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 don(
first. InstalloVinust 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 of
verbal OK from engineer must be submitted to Board of Health, after which installer calls foi
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.
3. As the installer I understand that persons or companies not associated with my company may
not perform the work required by my company 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 in the Town of North Andover plus
significant fines to all persons involved.
4. As the Installer 1 understand that I must be on site during the performance of the following
constriction 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. um chamber, retaining wall and other
d) Installation of tank; D-box, pipes, stone, vent, pump
components.
5. 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.
Unders' d Li e sed Se ti In aller
�. Date:
Disposal Works Construction Permit#
pYOf�'i'!y
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
27 CHARLES STREET
NORTH ANDOVER, MASSACHUSETTS 01845
Sandra Starr.,R.S.,C.H.O. Telephone(978) 688-9540
Public Health Director FAX (978) 688-9542
FAX
Bill Dufresne From: Pamela
To:
MERRIMACK ENGINEERING
66 PARK STREET
Andover, MA 01890
978-475-1448 Pages: ,2
Fax:
978-475-3555 Date:
Phone:
Septic Plan Response CC:
Re:
❑ Urgent x For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
e Comments:
Attached is the response from the Health Agent regarding Septic Plans for the following property:
1
A copy has also been mailed to the homeowner.
Please call 978-688-9540 for assistance with any questions. Thank you.
Cc: File
Homeowner