HomeMy WebLinkAboutHealth Permit # 8/11/2014 i
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Commonwealth of Massachusetts Map-Block-Lot
BOARD OF HEALTH Permit No
North Andover BHP-2014-0693----
P.I. FEE
F $250.00
DISPOSAL WORKS CONSTRUCTION I'T'
Permission is hereby granted Matthew Manning_------------------------------------------
to(Construct)an Individual Sewage Disposal System.
at No 51 STANTON WAY
as shown on the application for Disposal Works Construction Permit No. BHP-2014-069 Dated---August-11,2014-----
4 -----------------------------
Issued On:Aug-11-2014 B( RD OF HEALTH
«M .
.. .; Application r Septic Disposal System � o /y
m�ti0
Construction Permit — TOWN �i TODAY'S DATE
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ORI'I I ANDOVER, A 01845 $ 250.00—Full Repair
$125.00 -Component
Important: ApplicatioWs hereby made fora permit to:
When filling out Construct a new on-site sewa a disposal system*
forms on the g p Y
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
rQ Address or Lot#
7e, 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)
nfiltrator 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
G-- M-Z
Name
1679 ()_'Sr, 0cA s.-
Address(if different fro bove)
A)(),:�- /I ,& _ MA C) I io 9�
City/Town State Zip Code
Telephone Number
3. Installer Information
Name ./ A (� Name of Company
10 Addffress /( 77
City/Town St Zi Code
ftj l- � 9
T hd e Number(Cell Phone#if possible please)
4. Desioner Information j y
Name Name of Company
dOV S
Address
City/Town State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit-Page 1 of 2
KoRrH Application for Septic Disposal ystem 3 0/
O S, no n HO
�=:e6 op t.o®nstructi®n hermit TOWN �i TODAY'S DATE
pp��
ISO A 01845 $250.00
O TH -Full Repair
$125.00 -Component
SsgcNUs
PAGE 2 OF 2
A. Facility Information continued....
5. Type of Building: ❑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.
61 3 0/ /
N e Date
Applicatio,.�pprove y: (Board of Health Representative)
Narpe Date
d
Appli ;tion ZisappeLed for the following reasons:
For Office Use Only:
1. Fee Attached? Yes No
2. PfoiectManagetOhWgationFofmAttacbedP Yes No
3. Pump System? If so,Attach copy ofElecttical Permit Yes No
4. Foundation As-Built?(new construction ronly): Yes ✓ No
(Same scale as approved plan)
5. Floor Plans?(new construction only): Yes/ o
V
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 system) Fox plans by
(Engineer)
Relative to the application of M et4LV-4/ A4ei d , 2,. _ Li / azi �)
(Installer's name) And dated a �/
Ougi a ate)
Dated (� /� Z a
�/����y s date) With revisions dated y Z / 3
(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 rp for to
performing any work on a site. I must have the appr ved 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 (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: healthdeptktownofnortliandover.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 systems . 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, siggificant 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 by the homeowner,general contractor,or any other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: (Today's Date)
(Name— Print) K me—Stgne
PROFESSIONAL ENGINEERS AND LAND SURVEYORS
CS;
160 SUMMER STREET,HAVERHILL,MA 01830
tel:978-373-0310 www.csi-engr.com fax 978-372-3960
Soil Borrow Management
Title 5 sand at the Stanton Woods subdivision
Date: May 7, 2014
(Nate: revisions and new iter ns are in blue text) .
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
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 Envirom
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.
May 7,2014
7. A log book shall be kept by the site contractor/installer 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.
® Page 2
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