HomeMy WebLinkAboutHealth Permit # 10/2/2009 r
Commonwealth of Massachusetts Map-Block-Lot
106.00066
Board of Health Permit No
p BHP-2009-0686
North Andover -----------------------
P.I. FEE
.�,s •..,:,
AC J••°k'a`� F.I. $250.00
`'i
DISPOSAL KS CONSTRUCTION PERMIT
Permission is hereby granted -Joseph-Caruso----
to(Repair)an Individual Sewage Disposal System.
at No 239 GRANVILLE LANE
as shown on the application for Disposal Works Construction Permit No. BHP-2009-068 Dated_--October-02,2009
n
---------------------
Issued On: Oct-02-2009
S t'B and of Health
�4 d IIC tiOgn r t�C I I stem TODAY'S DATE
a"d pgdM if p�9
0
Construction r it — T F
°a ORTH ANDOVER A. 01845 $ 250.00 a Full Repair
$125.00 Component
Important: Application is hereby made for a permit to:
When filling out ❑ Construct a new on-site sewage disposal s stem*
forms on the g p y
computer,use
only the tab key 10 Repair or replace an existing on-site sewage disposal system*
to move your ❑ Repair or replace an existing system component—what?
cursor-do not
keY y the return A. Facility Information
-- __ _.-
pf°
Address or Lot# t _
-._ -..r --- ,
_ -
r�r�ron❑'�� City/Towntr T"7�
2.d*TYPE OF SEPTIC SYSTEW:
,mil 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
Name - - -
s(if different from above)
City/Town State Zip Code
> .
Telephone Number
3. Installer Information
G -
Name , y Name of Company
Address
City TXn �l St) 1� Zip Code
.t
e
Telephone Number(Cell Phone#if possible please)
4. Designer Information
Name p Name of Com annrG �tl
Address
City/Town State Zip Code
Telephone uN mber(Best#to each)
Application for Disposal System Construction Permit Page 1 of 2
o IiC ti®n for Sq2jjp o I tem
TODAY'S DATE
Construction Permit — T F
' w C) `T'I I ANDOVER, 01845 �X50.00-Full Repair
` $125.00 -Component
PAGE 2 OF 2
A. Facility Information continued....
5. Type of Building: fiesidential 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
Worth Andover, and not to place the system in operation until a Certificate of Compliance has
been issued by this Board of Health.
- t---- Dat- - -
Name Date
rf "7
Application roved r� � —
Board of Health Representative)Nam Date
'
App I,cation,dis app roved
r'
E
for the following reasons:
For Office Use Only:
Z Fee Attached. Yes 41oo No
2. Project Manager•Obligation Fortn Attacbed? Yes to No
3. Pump s stem? If so,Attach copy ofElectrical Permit Yes No (I�r
4. Foundation As-Built?(new construction ronly): YP.4 No
(Fame scale as approved plan)
1
5 Floor Plans?(new construction only): '
,e
Ar
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
,�� if (✓/�. ,.
�cla< f '
o
For b} L a_t�„_ gsety"')11k!"5
T'IfCCC j
Relative to the application of �,/s/" yi f �
�� iIIE r nsieMaC) And elated
rx.,ru<r c�,rCr�
Dated � ,�i ;tv ,/ � P
(g i m �, E mF') With revisions dated _2�d,/ �”
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 glans 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 the 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 OK (or e-mail to: .f:�:tlt,kw<l,f ,t(c;,c+ � ct e)ft 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 I may perform the work (other thali simple excavatioli)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 or consultant.
d. Installation of tank, D-Box, pipes, stone, vent,pomp chamber, retaining wall and other
components.
C. 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: I /~;" C
t � .
A4
,iatt�ta° r:tix[1 i�7tC ;;1i����'a)
Date..... .........
04 NORTH
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
�-
ss^CHUSE�
This certifies that ... r
..............
. .. ....... ....................................... .................
has permission to perform
4:6, V/ .....
wiring in the building 0 ...... .. ...................................................
117 — Il
.. .... ......z2zt7. I North Andover, ass.
at C� .......... ......... . ................. l(M)
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FeeLic.NdX) .................................................."t.. ....
ELECTRICAL INSPECTOR
Check It
9040
.;r
7 Commonwealth of Massachusetts Official Use Only
Fire Services Permit No. J70 r-t'0
Occupancy and Fee Checked 1A '`
r �a E ARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank
_� H r g,V{ � 1 , TION FOR PERMIT TO PERFORM ELECTRICAL WORK 11
fl�i All-- ork to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
PRINT
ININK OR TYPE ALL TNFORW TION) Date,
City or Town of 1�10ItTH ANDOVER /
To the Inspector°of'-Rh-es:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number)_ c ��rA-, �1'1 te
>
Owner or Tenant ��^y Telephone No.
Owner's Address �r...
Is this permit in conjunction with a building permi , s . '
❑ No ❑ (Check Appropriate Box)
Purpose of '
P Building— Utility Authorization No.
Existing Service Amps / Volts Overhead
❑ Undgrd❑ No. of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Com letion of the followin table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No. of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ® In- ® o.o mergency lg ng
rnd. rnd. Batter Units
No.of Receptacle Outlets No.of Oil Burners F P-E4 ALARMS No.of Zones
No.of Switches No.of Gas Burners No..of Detection and
Initiatin Devices
No.of Ranges No.of Air Cond. Tons No,of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: ............................... .. ....,.,.............
Detection/Alertin Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal
Connection ® Other
No.of Dryers Heating Appliances Imo' Security Systems:*
No.of Water No. of No.of Devices or E uivalent
Heaters KW of Data Wiring:
Si ns Ball.asts No.of Devices or E uivalent
No,Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
OTHER: No,of Devices or E uivalent
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electric 1 Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 1-0,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE 0--FOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: a �, n
Licensee: �"771./7 7,/•!� C C.�.Cc Signatur - � , LIC.NO.•
(If applicable, en,ter "exem t"in the license number line,)
Address: l c Bus.Tel.No.: c°` - i i
e2 5
*Per M.G. c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Alt L cl.No. � �
OWNER'S INSURANCE WAVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑ owner ❑ owner's agent.
Owner/.Agent
Signature Telephone No. PENT FEE. $