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HomeMy WebLinkAboutHealth Permit # 6/13/2007 ����� Commonwealth of Massachusetts Map-Block-Lot ®® ,, = -R� 107.6-0066- �,� .. ss� ----------- - Board of Health PennitNo ® North Andover BHP-2007-0179 P.I. FEE 04 F.I. Disposal Works Construction Permit Permission is hereby granted James H. Currier to(Repair-D-BOX)an Individual Sewage Disposal System. at No 1459 TURNPIKE STREET as shown on the application for Disposal Works Construction Permit No. BHP-2007-017 Dated June 13,2007 I Issued On: Jun-13-2007 Board of Health App1ication for Septic Dispo I t , , ; TODAY S DATE a- .Construction Permit - TOWN OF ORTH ®1 $25.0.00— Full Repair ANDOVER, � $125.00 - ompryrlent Important: ApK)lication is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use ❑ R air or replace an existing on-site sewage disposal system* only the tab key D to move your Repair or replace an existing system component®What? cursor-do not use the return A. Facility Information 11b Address or Lot# — — v, City/Town -- - � --- P c r wn 2.-*TYPE OFgjgPTIC Y TEW: ❑ Pu p Gravity (choose one) *If pump system, attach copy of electrical permit to application*** Conventional System (pipe and stone system) ❑ Infiltrator or Biodiffuser(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) ❑ Pressure Dosed (D-Box Present) S.A.S. 2. Owner Information Name e4, Address(if different from above) --------------------------------------------- -- ------- - City/Town State Zip Code Telephone Number 3. Installer Information , - --- - -- Name Name of Company / 3/ r - -% ------------------------------------------------------ -------------- - Address . — ,► - -- -- ------------------ -----1------" City/Town State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information - — -_- ---------__. ____. ----------- -------- ----- ------- Name Name of Company -- - --- Address City/Town State Zip Code Telephone Number(Best#to(teach) Application for Disposal System Construction Permit^Page 1 of 2 N ORTH Application for Septic Disposal System 04 A,0$ 6 1 OAConstruction Permit — TOWN OF TODAY'S DATE ORTH ANDOVER MA 01845 $ 2 50.00-Full Repair �9SSACNU $125.00 - Component PAGE 2OF2 A. Facility Information continued.... 5. Type of Building: sidential 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 i sued by this B and of Health. e Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: Z Fee Attached? Yes No 2. Project Manager Obligation Form Attached. Yes No 3. Pu np Sy—g r? If so,Attach copy of Electrical Permit Yes No 4. Foundation As-Built?(new construction ronly): Yes No (Same scale as approved plan) 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 SEPTIC SYSTEM INSTA-LLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: 6 77-- (,Wdress'ofseplic sys'tenl) For plans by (Engincer) Relative to the application of 011sialler's And dated date� Dated oaa`, <klfe) 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 pdor 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 fine being levied against me and/or my company. a. Bottom of Bed— Generally, this is the first (I") 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: lie,,tltl'iclwtC(�.)t-o'wiiofiiortl'iatido\'C cgiii) 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 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. Deteimination 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 of 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: 0:oday's Datc) ve, _(17'all-IC m­ prMt) 1,kKatne Signied) <�;� �� ,. �w�,:, �. �4 . : ��� � �r� .� ��y� �� i 4 �,,: ..��,, �w� �. . ,, .. VtORT� CI Ay6® 06s6�®0 tr 0 01-4 Couaiini°vma�qv .�l a a�ATOCI 0", � �CHUS PUBLIC HEALTH DEPARTMENT Community Development ment Division ❑y � QNSITE WASTEWATER SYSTEM CONSTRUCTION NOTES LOCATION INFORMATION MA P: LOT: S ❑p �..� . ;' � "� �': ADDRES INSTALLER' DESIGNER: PLAN DATE: BOH APPROVAL DATE ON PLAN: INSPECTIONS_... � � ,,' : .. . ,,�❑ ' °�;��'� ._ �. TANK INSPECTION: . , DATE OF BED BOTTOM INSPECTION: « DATE OF FINAL CONSTRUCTION INSPECTION: DATE OF FINAL GRADE INSPECTION: SITE CONDITIONS ❑ Existing septic tank properly abandoned ❑ Internal plumbing all to one building sewer ❑ Topograpky,not appreciably altered Comments: SEPTIC TANK ❑ Bottom of tank hole has 6" stone base ❑ Weep,,hole plugged ❑ 1500 gallon tank has been installed H-10 loading Monolithic construction ❑ Water tightness of tank has been achieved (Visual or Vacuum Test or Water held for 24hrs) ❑ Inlet tee installedw"centered under access port El Outlet tee (gas baffle or effluent filter) installed, centered under access port 1 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.fownofnorfhandover.com %AORTi4 0 00 � cac„t ow�a`v1. Top *3�s CMUS���� PUBLIC HEALTH DEPARTMENT Community Development Division ❑ 24” inch cover to within 6" of final grade installed over one access port, must be over outlet of tank if effluent filter is present ❑ Hydraulic cement around inlet & outlet Comments: PUMP CHAMBER ❑ Bottom of tank hole has 6" stone base ❑ Weep hole plugged ❑ Combo Tank installed. Size: ❑ 1000 gallon Pump Chamber installed H-10 loading Monolithic construction) ❑ Inlet tee installed, centered under access port ❑ Pump(s) installed on stable base ❑ Alarm float working ❑ Pump On/Off floats working ❑ Separate on/off floats ❑ Drain hole in pressure line ❑ 24" inch cover to within 6" of final grade installed over pump access port ❑ Water tightness of tank has been achieved Visual testing ❑ Hydraulic cement around inlet & outlet Comments: DISTRIBUTION-BOX Installed on stable stone base Inlet tee (if pumped or >0.06'/foot) . ,A ❑ Hydraulic cement around inlet & outlets ❑,' Observed even distribution Speed levelers provided (not required) Comments: 2 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.town0northandover.com %AORT11 0 7 0 CHUa PUBLIC HEALTH ET (ommunity Development Division SOIL ABSORPTION SYST (General) F-1 Bottom of SAS excavated down to 6 in into C soil \ layer, as provided on plan ❑ Size of SAS excavated as per plan ❑ `,Title 5 sand installed, if specified on plan ❑ 40 Mil HDPE barrier installed ❑ Retaining wall (boulder/concrete /timber/ block) ❑ Fi'n,al cover as per plan Comments: SOIL ABSORPTION SYSTEM (Gravel-ltiess Chambers) ❑ Brand find Model of Chamber Infiltrator Quick 4 ❑ Number,of chambers per row 9 ❑ Number f rows (trenches) 3 ❑ Laterals i stalled and ends connected to header (and vented if i pervious material above) ❑ Elevations f laterals and chambers installed as on approved pl n Comments: CONTROLPAN L ❑ Alarm & Pump re on separate circuits ❑ Alarm sounds w en float is tripped ❑ Location of contr I panel ❑ Rated for exterior 'f placed outside ❑ Alarm signal locat d inside Comments: 3 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.lownofnorthandover.com t4OR 11 .1jv.%D 16 �© 0 r q D�A tOCHIC IWICM`4^ Argo I'? � �CHUS PUBLIC HEALTH DEPARTMENT fommunity Development Division SYSTEM ELEVATIONS INVERT IN FIELD PLAN INVERT ELEV. Benchmark Building Seger OUT Septic Tank IN Septic Tank.OUT Pump Chamber IN Pump Chamber OUT Distribution Box IN Distribution Box OUT Lateral 1 INV Lateral 1 TOP � Lateral INV Lateral 2 TOP Lateral 3 INV Lateral 3 TOP Lateral 4 INV � Lateral 4 TOP 4 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofoorthandover.com '%AORTN Z. 0 CA 0 ATOP 0 cwus���� PUBLIC HEALTH DEPARTMENT (ommunity Development Division CRITICAL SETBACK DISTANCE Mark those distances checked in the field against the design plan and regulatory setback Tank SAS Sewer ❑ Property line 10 10 -- ❑ Ceflar wall 10 20 -- ❑ Inground pool 10 20 -- ❑ Slab foundation 10 10 -- ❑ Deck, on footings, etc 5 10 -- ❑ Waterline 10 10 101 ❑ Private drinking well 75 1001 50 ❑ Irrigation well 75 100 ❑ Surface Water 25 50 ❑ Bordering Vegetated,Wetland , Salt Marsh, Inland/Coastal Bank 75 100 ❑ Wetlands bordering surface. water supply or trib. (in Watershed) 150 150 ❑ Trib. to surface water supply 325 325 ❑ Public well 400 400 ❑ Interim Wellhead Prot. Area ❑ Reservoirs 400 400 ❑ Drains (wat. supply/crib.) 50 100 ❑ Drains (intercept g.w.) 25 50 ❑ Drains (Other)Foundation 10(5)'`,,•., 20(10) ❑ Drywells 20 25 1 Suction line 222(2) 2 100 feet is a minimum acceptable distance and no variance is allowed for a lesser distance(NA 5.02). 3 As defined in 310 CMR 10.55, 10.32, 10,54,and 10.30,respectively,pursuant to 15.211(3), also by NA wetland bylaws 5 1600 Osgood Street,North Andover,Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthondover.corn