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Home My WebLink AboutHealth Permit # 4/2/2007 ock-Lot 9 3_1 - 0 Map-BI 7 ock-Lot Commonwealth of Massachusetts �ORTP4 1063.A-0131 0 41 --- ------- Board of Health Permit No 0 0 BHP-2007-0062 Andover ----------------------- North Andover FEE P.I. $250.00 ----------------------- C NO F.I. Disposal Works Construction Permit Permission is hereby granted John ----------S--o--u--c-y----------------------- --------------------------- --------------------------------------- to (Repair)an Individual Sewage Disposal System. atNo -445 FOREST STREET------------------------------------------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2007-006 Dated. April-02,-2007_--_-__ ------------ ------------------------ ----------- -- Issued On:Apr-02-2007 --------- - - ----------------------------------------------------------- � � TODAY'S DATE Construction it 01845 2 50.00Full Repair air 41* ' 126.00 -Component CWU'6''�R Important: Application is hereb made for a ermit 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 use the return A. Facility Information key. _ ------ -- t' �= --- -- - -------------------------------------------------------- Address or Lot# ------ -- „ m City/Town rerwn *TYPE.OF SEPTIC SYSTEM*: Pump El Gravity(choose one) ***1 pump system, attach copy of electrical permit to application*** conventional System (pipe and stone system) A ❑ Infiltrator or Diodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system.) k ❑ Pressure Distribution S.A.S. (No D-Sox) Y ❑ Pressuree Dosed(D-Box Present)S.A.S. " f ne system ' el e Yes x e mY S tl therinf rmatinn neededf TO insts/let�iest' fy lirand oi / f b e D WGr s issued Wha Cis the Make? W/iat is the Model? 2. Owner Information Name Address(if different from above) City/Town State Zip Code �. Telephone Numb l,, (r „ 3. Installer Information Name �y r_ Name of Comps y Address -- - - --------- - -- -- — City/Town State Zip Code - --- Telephone —L _ _ Nu ber(Cell phone#it possible please) --- 4. Pain�r Inf�rmati�n Name Name of Company Addre s - ----- City/Town State ----- — - - —— -------- — p e Telephone Number(Vest to Reach) ---- -------- Application for Disposal System Construction Permit•Page 1 of 2 as to -fog tic D I d _ --- �� TODAY'S DATE - Construction Permit / ORTH ANDO)�E& MA 01845 250.00- Full Repair/ Aa 'pppTap $125.00 -Component CMiUp"i PAGE 2 F A. F cillf F Information continued.... 5. j 2f UIl in : Residential Dwelling or nCornmercial 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 Environmen I Code, as well as the Local Subsurface Disposal Regulations for the Town of North An er. I understand that until a final Certificate of Compliance has been issued to r this Boa 4f HeaYstalled system is not approved. - - - -2----rte Name---- Date Application Approved IS (Board of Health Representative) uate Application Disapproved for the following reasons: For Office Us2 Only, 1 F°ee A ttacbed .Yes ✓ No 2 Project Manager Obligation Form Attacbed? Yes I,'� NO 1� � 3. Pump-Sys te�? If so,Attach coQv of Elecaical Permit YeIq_/ NO 4 Reviewed approval letter, all paperwoik received? Yes No Missing..- 5 F'ouixdation As-Built. (n nsftuction only): Yes .loo__ (Same scale as approvedpla4"" 6 .Floor Plans?(new construction only): "rv..-_' 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: 11 (Address of"septic systcmx For plans by �✓ � � ��= (littginc^er) Relative to the application of 1 � t (l istall€�.r's name) And dated � � � �� j Pt rlgtrta 4,ate. Dated ] c / `— C )'W / oa m,s c ate _ With revisions dated (l...ast revised datc) 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 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 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 file being levied against me and/or my compare a. Bottom of Bed—Generally, this is the first (1`) inspection unless there is a retaining wall,which should be done first. "I'he 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 OK (or e-mail to: l?ealthc cat x)tc>�utI cILIIL)l-tlianclo—,,eer.coLii) from the engineer must be submitted to the Board of Health, after which installer calls for an inspection time. Installer must 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 must request inspection when all grading is complete. Installer does not have to be on-site. 4. As the installer, I understand that only 1 may perform the work (other than sihiple exeawliora)and I am 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 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 o!•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 solelv res onsible for the installation of the system as per the approved lans. No instructions by tl otneowner general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: �t�,, vc (Today's l)rte) ame —,.tgneC _�. The Commonwealth ad Massachusetts Oft UN 0* rNO..__.__..__._- ��.�-�-_ Department of Public Safety v& BOAAD OF FIRE EVENTION REGULATIONS 527 CMR 12M 3 IQ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOM to In Coft 52 CMN to (PLEASE PRINT IN INK OR ALL INFORMATION) Data City or Town / ..c/ �✓ m Co amid,. undereigned appilee fora permit to porlorm ofttrW work dmribW Uxabw(Street&Number) Owrw or A T Owntee r In mh In jun with a bukAnq pwmit: Yes No (C Purpow of Bulldlrlg r UtW A~uMori No I A/ Vealta Oveftad GUndgrd 0 No.of Meters Undgrd No.of Melare Number of LoCation and rq cat /% _ X1 ,of Transibmwe ktVdA Cr�tore K Date...................... ... ....... UnIto IRE RM$ No. yORTH T'®VVfN OF NORTH ANDOVER � ► ' ON ® : No.of dl n PERMIT F® rVV I R 1 t`d No.rat Sa saw a C Q nr r •DAq TiD h9*��.(eJ eo+us�t L U n LOW Ww'"o This certifies that .. ........ ... has permission to perform ' wiring in the building of... ..... :. ...r:. ......... ... ..... .. ........., North,Ando v er,Mass. tlnl equivalimit. Vag NO Fee. ............... Lic.No., .!.....::", ..... y. )?LECPRICALSA CTOR Check # b -- ( pI Wuty- FIRM NAME LIC. / Sun.Tot. �" Addmu Aft.T .NFa OWNEWS INSUIRANCE WAIVER, I am aware Mat ft tftn InguffiAm covvap or itn subetamw equivagem requfmd by n, my signatum ant this Ir owrw C3 4 0 ( ) or E E --