HomeMy WebLinkAboutHealth Permit # 11/22/2013 • Map-Block-Lot
Commonwealth of Massachusetts
"t�t xp ` -'• 061.00016
-------- ------------
BOARD OF HEALTH
Permit No
North Andover BHP-2013-1042
FEE
$250.00
DISPOSAL WORKS CONSTRUCTION PERMIT,
Permission is hereby granted Matthew Manning________________________________________-_____-_
to(Construct)an Individual Sewage Disposal System. ... ...........................
at No 1679 OSGOOD STREET La , I ____ l!J_____ _____ _-St
------------------------------------------- - - --L---3 pp p 013-104 Date November 19,2013
as shown on the application for Disposal Works Construction Permit No. BHP-2
Issued On:Nov-22-2013
BOARD OF HEALTH
SEPTIC SYSTEM INSTALLER PR ►JECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
L e%,t
(Address ol7septic system) For plans by (Engineer)
Relative to the application of m&kAket'-, Mo. 10,
qnstaller"s name) �'J And dated
(Urigin2l date)
Dated
(I or ys date.. With revisions dated
(Last revised date)
I..........I'll
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 appro plat4i*'i�i(�,6
perforrriing,uay work on a site. I must have the K_-_)provedplaps and the L)ern-iitv�/,�Inlisit(.-,wl-ien anv work is &
/tj R,
being done. f ( �`
2. As the installer, I must call for any and all inspections. If homeowner, contractor,project' a
dger, or ny-Y'
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 cornpleted prior to the applicable inspections as
indicated below. I understand that requt--stfiiganinspection, without completion of the items in accordance
with Title 5 and the Board of Health Regulations may result in 2$50.00 fine being levied against me and/or
my C0111parly.
a. Bottom of Bed-Generally, this is the first (V inspection unless there is a retainingwall,which
should be done first. The ii-istaller must request the inspection but does not have to be present.
b. Final Construction Inspection-Engineer rnust first do their inspection for elevations, ties, etc.
As-built of verbal OK (or e-mail to:heald-idepCcD
,townoffiortharidover.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 punip to work and alarm to fin-iction.
c. Final Grade-Installer must request inspection when all gradfi-igis complete. Installer does not
have to be on-site.
4. As the installer, I 1-understand that only I may perform the work(other thannivple 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 in North Andover can constitute
reasons for denial of the system atid/or revocation or suspension of my license to operate in the Town of
North Andover, significant fines to all Rens—ons 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,
r. 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 homePVn_,_1e_r.1_&e er contractor, or ariv other persons shall absolve
me of this obligation.
Undersigned Licensed Septic Installer: i 146 (Today's Date)
,7
/V1aAI 0
1 L
Na e- -rint _j
\
lication for S, pliq
Construction Permit — TOWN OF
/ov&Sux/E /
' NORTHANDOVE 01845 $ 28lUD—Fu | Repair
$125.00 Component
Important: Application is hereby made for a permit to: )
When filling^ / �
���mo~ � C��� ar� m�� s�� �p�� ���
computer,use [] Repair or replace mn existing on-site sewage disposal system*
only tho tab key
m move Your [] Repair or replace on existing system component—What?
cursor do not
use the return
key. A. Facility Information
VQAddress or Lot#
'If pump system, attach copy of electrical permit to application**
Conventional System (pipe and stone systern) ..........
M'Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of Your cerlification to Install this type of system.
[] Pressure DistribUtion S.A.S. (No D-Box)(Attach Draft Maintenance Agreement)
[lProsmu`e Dosed(D-Bnx Present)S.A.S.
2. Owner Information `
Address(if different from above)
City/Town State Zip Code
Telephone Number
3. Installer Information ,
Name Name of Company
Acickess
City/Town State
Telephone Number(Coll Phom#if possible please)
�
`
4. Desiciner Information
Name Name of Company
Address
CitylTown State Zip Code
6-1e—p In o n e N u)b er(B e s t#t�o Re—an h)
i
Application bvDsposal System Construction Permit'Page 1of2
3
NoR7H Application for Septic Disposal System TODAY'SDATE
Q t `
construction Perm
® 'I`
# -- -- $250.00—Full Repair
p ,o
oRTII A D VE 01845 $125.00 -Component
9SSACHV�E
PAGE 2 OF 2
A. Facilit Information continued....
5. Type of Buildi_n : BResidential 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
Environmenta}Code, as we
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.
i
Application proved By: (B and of Health Representative}
dt l � 3
Date f
Name
Ap ' ation Disapproved for the following reasons:
For office Use fJnly:
Yes No
1, Fee Attached?
2. ProjectManaffer ObIts Lion Forrn Attached? Yes
No
3, Fgalp Systern? If so,Attach cQp v of Electrical Permit Yes
No
g, P'otzndation As-BurIt?mew construction ronl
y), Yes No
(Sarne scale as approvedplan)
5, Floor Plans?(new construction only).
Yes No
Application for Disposal System Construction permit•page 2 of 2
PROFESSIONAL ENGINEERS AND LAND SURVEYORS
Csi
160 SUMMER STREET,HAVERHILL,MA 01830
tel:978-373.0310 www,csi-engr.com fax 978-372-3960
Soil Borrow Management ...
rl t1
Title 5 sand at the Stanton Woods subdivision
Date: May 7 2014
� Nt1,5(t "4,,A:it
(dote: revisions and new iterns 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,
6. 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.
I
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.
i
® Page 2
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