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HomeMy WebLinkAboutHealth Permit # 11/1/2005 Town of North .Andover, Massachusetts orm N�x ° p, 3 ,aoe l'h .; BOARD OF- HEALTH 115 DISPOSAL WORKS CONSTRUCTION PERMIT SACHE {! Applicant ADDRESS TELEPHONE Site Location � ' � X21 Permission is hereby granted to Construct ( air or Re ` � ) p� •�""°an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S, No. CHAIRMAN, BOARD OF HEALTI ( t F'Ce �'� � . D.W.C. No. INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at / - relative to the application of'-fi e tat ted for plans by w , �� r,itb ri1�u 11 and dated/<�_n '3_r, --o,,.(. with revisions dated J. ` t I understand the following obligations for management of this project: I. 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 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 manger, 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 Tile 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, ties, etc. As-built or verbal OIL from engineer must be submitted to Board of Health, 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. 4. As the installer I understand that only I may perform the work (other than simple excavation) required 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 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 by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed µpstaller pt o, Date._ � ` "' p� l i c I n for - .. Construction Permit, TOWN TODAY'S DATE �'` • ` ' O1 25Q.00.:,. Full Repair 5 ? X125.00 -Component Important: Application is hereby made for a permit to: When filling out ❑ Construct a new on-site sewage disposal system* forms on the computer, use al epair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system components cursor-do not use the return key. �• Facility Information ab Address or Lot# ........... -._ . - --- erwn City/Town & ­ _411 2.- *TYPE OF SEPTIC SYSTEM*: ❑ Pump ® ravity (choose one) ***If pump system, attach copy of electrical permit to application*** f ❑ 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 __.---- JJ Address(if different rfrom above) r g ./\C t �1 VL City/Town State Zip Code Telephone Number s. Installer Information p c ry r, f") q✓" U" U 1 l..c..t.C. ."�p 4,�,.„,� Name t Name of Company C A dress City/Town State e Zip Code ._ Telephone Number(Cell Phone#if possible please) 4. Designer Information me�A ­ f' r ... 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