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HomeMy WebLinkAboutHealth Permit # 7/17/2014 Map-Block-Lot • Commonwealth of Massachusetts • r �, ----------------------- �• PermitNo BOARD OF HEALTH BHP-2014 0 0696 ----------------------- FEE North Andover FEE P.I. $250.00 --------------- F.I. DISPOSAL CONSTRUCTION PERMIT Matthew Manning ------------------------------ Permission is hereby granted ---------------------------- ---------------- -------------------- --- ------ to(Construct)an Individual Sewage Disposal System. at No 65 STANTON WAY - -------- - --- - --- ----- - ------ ---------- - -- - - - ------------- - - - isposal Works Construction Permit No. BHP as shown on the application for D -2014-069 Dated ,_July-1 201,- -_-- ------------- - --------------- BOARD OF HEALTH Issued On: Jul-17-2014 H°NTH Application for Septic Disposal ystem 6 o 1,L/ Q � O trio�°.h� 0� d . oaonstruction Permit — TOWN F TODAY'S DATE . , 01845 $250.00 S l�'I H ANDOVER, —Full Repair �'';�y $125.00-Component SA US Important: Applicatiopis hereby made fora permit 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 key.y the return A. Facility Information rd 1 J Address or Lot# City/Town 2.-*TYPE OF SEPTIC SYSTEM*: ❑ Pump ravity (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 . /vk.Z T c,.s.A-- Name 1 6 7 1 C} ,.,ocA S­�- Address(if different fro bove) /jn':k�X A M A 0 1 � �� City/Town State Zip Code Telephone Number 3. Installer Information MnA A4�o McL^ni fl �_5h Z)-, 7V �c: c Oc c A y-­ ;o o Name Name of Company I0 O'A Address City/Town St Zi Code 1& �® TNUphofie Number(Cell Phone#if possible please) 4. Desic ner Information Name Name of Company 160 ISVICAolle-` S� _ Address City/Town State Zip Code (0,7q) 3723- 0 Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 ,ar �icatin for p 0 Construction Permit TODA 'S DATE . I ORTH ANDOVER, 01 $250.00—Full Repair $125.00 -Component PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Bulldin: Residential 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 North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Na �` Date s Application A rov By: (Board of Health Representative) Namer Date Ap ication Disapprov for the following reasons: For Office Use Only: L Fee Attached, Yes No 2. Project Manager Obligation Forrn Attached. Yes No 3. Pump System? If so,Attach copy of Electfical Permit Yes No 4. Foundation As-Built?(new construction ronly): Yes No (game scale as approved plan) 5. Floor Plans?(new construction Only): Yes 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: (address of septic sl L stein) For plans by (Engineer) Relative to the appli cation of Lt�� L j m ei a ai (Installer's name) And dated Li V/ 3 7 �1 (Original ate) Dated � b 6 /� l ( o aj s ate) With revisions dated (Last revised date) 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 eded 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 fine being levied against me and/or my company a. Bottom of Bed—Generally, this is the first(V5 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: healthdeptatownofnorthandoyer.com) 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 than simple excavation)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 stems 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,pump chamber, retaining wall and other components. 6. As the installer,I understand that I am solely responsible for the installation of the system as per the approved plans No instructions bathe homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: 6116 (Today's Date) (Name—Print) 0 ( -ie—Signed) f � PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET,HAVERHILL,MA 01830 tel:978-373-0310 www.osi-engr.com fax 978-372-3960 Soil Borrow Management Title 5 sand at the Stanton Woods subdivision Date: May 7, 2014 k_1 (dote: revisions and new items are in blue text) 1\ , 1. Sand that is intended to be used shall be stockpiled prior to sampling. Sand from each source location shall be placed in separate stockpiles for inspection and sampling. If during excavation the sand from a single source contains variations in color, consistency, or gradation a separate stockpile of each variant shall be made. A plan shall be prepared showing the locations of the stockpiles and the sources of the material. The project engineer (Christiansen & Sergi, Inc.) shall provide a base map to the site contractor/installer that the installer will update whenever sand is excavated, stockpiled, or moved. Copies of the updated plan shall be submitted to the Health Department within 48 hours of any new sand excavation, stockpiling, sampling, testing, or filling. 2. Prior to the sampling of sand from a stockpile an inspection shall be made by the Health Department or their designated representative to ensure the consistency of the stockpiled material and to ensure that the sample is a valid representative of the material in the stockpile. The Health Department may authorize a representative of the site contractor/installer, such as the project f engineer(Christiansen & Sergi, Inc.)to inspect and approve the sampling. 3. Samples to be tested shall be clearly labeled as to the source of the material and the location of the stockpile. 4. On-site sand shall not be used as the "System Sand" for the Presby Enviro- septic systems to be constructed on Lots 1 and 4. 5. If necessary, stockpiled sand shall be screened prior to placement in the disposal area to ensure that no material larger than 2 inches is present. 6. If during the placement of sand in the disposal system it becomes necessary to use sand from two or more stockpiles an inspection shall be made by the design engineer, Health Agent, or Mill River Consulting prior to the placement of the sand from the second (or subsequent) stockpiles. f (<y I May 7,2014 7. A log book shall be kept by the site contractorfinstaller to document all activities relating to sand excavation, stockpiling, sampling, testing, and filling. Copies of all test results shall be kept in the log book. A copy of each new log entry shall be submitted to the Health Department within 48 hours of any new sand excavation, stockpiling, sampling, testing, or filling. 8. The Soil Borrow Management Plan will be incorporated into each DSCP issued for this project so it is acknowledged by the licensed installer as to the plan and procedures to be followed. 9. The site contractor/installer shall inform the Health Department which testing lab will be doing the testing prior to the sample being taken. 10. The Health Department will plan to take composite confirmatory samples at some or all of the onsite wastewater systems during installation. In addition to usual fees a regular"additional inspection fee" of$50 will be calculated per trip to the site; along with the ongoing soil sample charges. Outstanding payment shall be made prior to issuance of each Certificate of Compliance. 11. The installer is apprised that a Certificate of Compliance cannot be issued if a soil sample is taken at a particular onsite wastewater system until such time as the laboratory results confirm compliance with Title 5 fill specifications. Failure will result in removal of all sand in that particular system bed. 0 Page 2 0 J (Q N F V� (n W W c u� U { � Z �/� Q v! a a `b E!� rL ; E. ¢ BRADFORD STRHEf Q W o N O m J H=\o O Z Q J ev l Q IO� W W fN— LLo o m O Z iui O Z Q U W Lu o a a' '.. J a O Z (q O LL O a � O CO oM � 0< 0 N J N N 0.K Y - N c7 V u] CO 1� tb �•'� 1 O ----� m co i ) / n n 11 V. �\ J 4 O N \ N A � O \ 1-- i rc M Al 4.