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HomeMy WebLinkAboutHealth Permit # 4/7/2000 Form No. 3 Town of North Andover, Massachusetts D BOARD OF HEALTH NORTH • pt<' a o y e e'1'pp Z. DlSpOSAL WORKS CONSTRUCTION PERMIT 1SSACHU5� TELEPHONE ADDREs Applicant , NAME Site Location an Individual Soil Absorption d to Construct ( or Repair ( ) � Permission is hereby granted Approval S.S. No Sewage Disposal System as shown on the Design / HAIRMAN,BOARD OF HEALTH C D.W.C. No : Fee , APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT o DATE: , ' � �� •• CURRENT INSTALLER'S LICENSE LOCATION: zaz r p a r LICENSED INSTALLER: SIGNATURE: TELEPHONEm .s ), CHECK ONE: REPAIR: NE'VV CONSTRUCTION; t° " IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS—BUILT. Administrative Use Only 575.00 Fee Attached? Yes No Foundation As-Built? Yes t w .. No Floor Plans? Yes NTo ro gal PP Date: A . k INSTALLER PI2C3,TEC T MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at relative to the application of dated 411171jo for plans by� , , err and dated with revisions dated *othe 1 understand and Jae'e following obligations for management of this project: 1. As the installer I am obligated to call for any and all inspections. If homeowner, contractor, project manger, or any other person not associated with my company schedules an inspection and the system is not ready then item two shall be applicable . 2. 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 my company. a) Bottom of Bed—generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present, b) Final Inspection—Engineer must first do their inspection for elevations,des,etc. As-built or verbal OK from engineer must be submitted to BOH, after which installer calls for inspection time. Installer must be present for this inspection. With 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. Does not have to be on site. 'g 3. As the installer I understand that persons or companies not associated with my company may not perform the work required by my company to complete the installation of the system identified in the attached application for installation. I further understand that work 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 in the Town of North Andover plus significant fines to all persons involved. 4. 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. d) Installation of tank,D-box,pipes, stone,vent,pump chamber,retaining wall and other components. 5. 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 License ept I er . Date: