HomeMy WebLinkAboutHealth Permit # 4/4/2006 Map-Block-Lot
Commonwealth Commonwealth of Massachusetts
�� y. •� 0,� 106.A 0090-
Board of Health Permit No
North Andover BHP-2006-0074
c4 P.I. FEE
F.I. $125.00
Disposal Works Construction Permit
Permission is hereby granted Todd Bateson
-- --- -- ----- -------- -------- ------ --- -- - --
to(REPAIR-D-BOX&T BAFFLE)an Individual Sewage Disposal System.
atNo 72 PATTON LANE
as shown on the application for Disposal Works Construction Permit No. BHP-2006-007 Dated April 04,2006
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Issued On; 6 Apr-04-200 rdfTPlr
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Construction Permit
$ 250.00®Full Repair
I, ,,E" $125.00 Component
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Important: Application is hereby made fora permit to:
When filling out [] Construct a new on-site sewage disposal system*
forms on the
computer, use ❑ Repair or replace an existing on-site sewage disposal system*
only the tab key ❑ c „
to move your a pair or replace an existing system component ❑ y
cursor-do not
use the return A. Facility Information
key. y /
r�D Address or Lot#
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City[Town we V
2.® *TYPE OF SEPTIC SYST'EW:
❑ pump ravity (choose one)
***If pump system, attach copy of electrical permit to application***
❑ Conventional System (pipe and stone system)
❑ Infiltrator or Biodiffuser (gavel-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 -- -
Addressed different from above)
City/Town
y n State Zip Code
Telephone Number
3. Installer Information
Name Name of Company
Address
City/Town j 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 peach)
Application for Disposal System Construction Permit•Page 1 of 2
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INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the
Jo,J '/"I, relative to the application
property at /
Of "` � �rs°`� dated � 3��_ e 6; for plans by and
dated with revisions dated
I understand the following obligations for management of this project:
1. As the installer I am obligated to obtain all permits and
Boaalth approved the permit s priotr
to performing any work on a site. I must have approved plans
when any work is being done.
2. As the installer I must call for any and all inspections. ff 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 necgssary 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 riot have to be present.
b) Final inspection — Engineer must first do-their inspection for elevations, ties, etc. As-built or
verbal OK from engineer must be submitted
ent for this inspection. Withteprumpt system all relectrical
inspection time. Installer must be p
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 Lic se Septic Installer
Date:
Disposal Works Construction Permit#
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TOWN OFN011'114 ANDOVER
y1 Y
'VEIAWNIENT AND SIJIRV
Office of('01"VEN/fUNITY DL ICES
I-1EA1.311 DE11,-XRTMEN'T
100 OS
wq,❑ ^lye
GOOD SIRI"J"T
NORTH ANDOVt-',It,(\Ii\SS/\CIIIJSF I"I'S 0 1945
SLISMI Y. Sawyer, REI-IS/RS 978.688.9540 Phone
Public I Icalth Director 978.688.8476— FAX
QNSITE WASTEWATER SYSTEM CONSTRUCTION NOTES
LOCATION INFORMATION
ADDRESS: ;/Z,,, L,t-.-4? MAP: LOT:
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:
/70-
SITE CONDITIONS
ElExisting'se septic tank nk properly abandoned
,
E
.]Internal plumbing all to one building sewer
❑Topography not appreciably altered
Comments:
SEPTIC TANK
Bottom of tank hole has 6" stone base
F-1 Weep hole plugged
F-1 "'1500 gallon tank has been installed
14,10 loading Monolithic construction
❑ ❑ (
al'or tightness of tank has been achieved
"t,or Vacuum Test or Water held for 24hrs)
p"'I et tee entered under access port
�),ostalled c
cutlet tee .as baffle orbffluent filter) installed,
centered uWd'er acce�§s`port
24" inch cover t&,within 6" of final grade installed over
one access port, "us
M tbe over outlet of tank if effluent
filter is present
❑ Hydraulic cement aroun"61"idet & outlet
Wastewater System Documentation—Feb 2006
Page I of 6
TOWN1 OF NORTH ANDOVER
ro
t°t°n t`
� .°tit DEVELOPMENT
MENT AND ` . . `'°
HEAL'f 400 OSGOOD STREET
y Y yW" C5
�47RTI1 A1`wIl)(:)VE'R, iv1A`SACHUSETTS 01815 S'cwau��``
StISf11) Y. Sawyer, RE11l RS 978.688.9540 Phone
Public Ilealth Director 9'78.688.8476 FAX
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
❑ Pimp On/Off floats working
❑ Serate on/off floats
❑ Drain" 4ole in pressure line
❑ 24" inc ,,cover to within 6" of final grade installed over
pump access port
❑ Water tightn°ess of tank has been achieved
Visual testing
❑ Hydraulic cement around inlet & outlet
Comments:
ADVANCED TREATMENT° TECHNOLOGY
❑ Type of treatment device:
❑ Installed per manufacturers requirements
❑ All components working in accordance with
manufacturer's requirements
Comments:
Wastewater System Documentation—Feb 2006
Page 2 of 6
TOWN OFMAITH ANDOVER
Office tad`(,1'( A/#1N/1UN1'FY I)F.Vf!',I-,OPi'vii','N't' ,,.kND SERVIa"S
11EALTH DEPARTMENT
400 OSGOOD STREET 41
NORTH i\Nl)(')VI�-'IZ, ,\/I \SSACII(-jSE'l"I'S 018,15 US
Swan Y, SaWyCl', REHS/RS 978.688.9540 - Phone
Public Health Director 978.688.8476 —FAX
D-BOX
Installed on stable stone base
EVI Inlet tee (if pumped or >0.08'/foot)
,Hydraulic cement around inlet & outlets
Observed even distribution
levelers provided (not required)
Comments:
SOIL ABSORPTION SYSTEM
❑ Bottom of SAS excavated down to soil layer, as
provided on plan
F-1 Siie of SAS excavated as per plan
F-1 Title`'5 sand installed, if specified on plan
F-1 3/4-1 Y2" double washed stone installed
F-1 1/8-1/2" (peastone) double washed stone installed
❑ Laterals installed and ends connected to header
F-1 Laterals vented if impervious material above
❑ Orifices @ 5 &7 o'clock positions
❑ Gravel-less dispbs'al systems: type, number and
location as per plan",,,,,
❑ Elevations of laterals installed as on approved plan
F-1 40 Mil HDPE barrier installed
F-1 Retaining wall (boulder/ concrete /timber/ block)
F-1 Final cover as per plan
Comments:
Wastewater System Documentation—Feb 2006
Page 3 of 6