HomeMy WebLinkAboutHealth Permit # 4/19/2000 rokti
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APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: t.-� 1" f 4.1" CURRENT ENSTALLER'S LICENSE
LICENSED INSTALLER:
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NESIGNATURE: TELIP Om
CTECK ONE•
,
REPAIR: NEW CONSTRUCTION:�`1
IT NE W CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT,
Administrative Use Only
S75.00 Fee Attacked? Yes NO
Foundation As-Built? Yes No
Floor Plans? YeS No
Date: -�
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Approval "
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INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the property
at �' �(, � t w't relative to the application of
dated I'`1 for plans by,I\1< �^ ti cl, �� and dated l c. with
revisions dated
I understand and agree to the following obligations for management of this project:
1. As the installer I am obligated to 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 two shall be applicable .
2. 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 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 BOR 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.
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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 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.
d) Installation of tank,D-box,pipes,stone,vent,pump chamber,retaining wall and other 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.
Undersigned Licensed Septic Installer
Date: