HomeMy WebLinkAboutHealth Permit # 8/10/2009 Map-Block-Lot
�a� w Commonwealth of Massachusetts 104.80064
Q
-----------------------
------ - -----------
,Y` 6�� Board of Health Permit No
o BHP-2009-0646
North Andover
FEE
y . P.I. $250.00
F.I.
�gr..wu
DISPOSAL WORKS CONSTRUCTION IT
Permission is hereby granted Mike-Reilly--------------------------------------------------------------------------------
to(Repair-Complete System)an Individual Sewage Disposal System.
at No 136SAWMILLROAD -- ---
- ----- -- ----- - -------- -----------
------ - ------- -
- --------- - -------- - -
as shown on the application for Disposal Works Construction Permit No. BHP 2009 064 Dated August 10,20
----
- mz --
---
Issued On:Aug-10-2009 Board of Health
e
TODAY'S DATE
� IX V 0184 250.00®Full Repair)
k
; ; 125.00 -!component
Important: Application is hereby made for a permit to:
When filling out ® Cpnstruct 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
to move your ❑ Repair or replace an existing system component®What?
cursor-do not
use the return
A. Facility Information
key, °2 �,� t,4,?r ` � � � � � ,
r d Address or Lot#
City/Town
2 TYPE OF SEPTIC SYSTEM*:
Dump ❑ 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
�r
....��r .. o --)z �. ..�, ' a 2L
Name
Address(if different from above)
City/Town - State Zip Code
Telephone Number
3. Installer Information
Name y} � Name of Company,
Address —
City/Town St/ate Zip Code
/? ) d ' IX"y'- ) .,r
ephone Number(Cell Phone#if possible please)
4. Desimer Information .."
Li e
Name Name of Company
a
Address g
City/Town State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal System Construction Permit-Page 1 of 2
WN OF T „ m
11 tl 11 for tIC 1 L �! t
A rS
y DATE
p � X1"1 tf�Utlf1 C° It
mr oNa" $250.00®Full Repair
w
0145 $125.00 -Component
PAGE 2 ®F2
A. Facility Information continued....
5. Type of Buildinct: 'esidential 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 issued by this Board of Health.
µ,.
Date
Name
pp y
' atl h A rave .,,� r Ord of ,ealth Represent J /)A J
/ Date e ;' �
Application Disapproved for the following reasons;
For Office Use Only:
1. Fee Attached. Yes ,f No
Z, Project Manager•Obligatior7 Form Attached? Yes_' No
3. Purnp S ystem? If so,Attacli copy ofElectrical Penn it Yes Na
4. Foundation As-Built?(new construction ronly): Yes No
(Sarne scale as appravedplan)
5. Floor Plans?(clew construction Only): Yes No
Application for Disposal System Construction Permit>Page 2 of 2
SEPTIC SYSTEM INSTALLER PROJECT"MANAGEMENT OBLIGATION
As the North Andover licensed installer for the construction .for the septic system for the property at:
,.^(.aCcre-�"+ k =F Caa tor Plans b} 0'.t f k"1C
r
Relative to the sta�livaticrn o1 , t,:klk.e''�, ra,ntita
!i ti 9
And dated
Dated
�["Ikp[H"➢S0...a;1fF,'")
with revisions dated
N'A''t r"�p'(' P
I understand the fallowing obligations for management of this project:
1. As the installer, I am obligated to obtain all permits and Board of I Iealth approved plans prior to
performing any work on a site. I must have the aj)pr�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 inanager, 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 necessar~,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 agtunst me and/or
my company,
a. Bottom of Bed–Generally, this is the first (15) inspection unless there is a retalining wall,which
should be done first. Tlle 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 O (or e-mail to: hoti�in��:��,W L( , L�fl (- :^k.�,q,—�,b�����(<-r,t�u) from the engineer must
be submitted to the Board of Health,after which installer calls for an inspection tithe. 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 sloes not
have to be on-site.
4. As the installer, I understand that only I may perform the work (otber tban si»ple excauilion)and I am required
to complete the installation of the system identified ill 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 perfonznance 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 tang, D-.Box,pipes, stone, vent, pump chamber, retaining wall and other
components.
G. As the installer, I understand that I atn 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 obli ration.
Undersigned Licensed Septic Installer: �j�;��
7'a�
t'``1y ., :•,4- ?•r.;11 3,-....__.) a t!",1 +."�� .��t LY,_ 3- t.{l.;i;SY -T � .,. a f::at �... a 1t€ ) kg._
t1, fi.1.,, --f ..S?,x.`'r,;`{: :, !' -f`.,:., h ;d;✓.. rY. - �'S _ a4.a•:?) r3. Fz. .S .� u-, .'-
tt��.:E . f}� '� °•:+�€a �.5� ^�. �T s,��'t-'a ... x„..s Y<�� .A.:�d..ff t�z.. 3.'�a.�.175.)r'�,.f.,-(5„ F) { � tJ!k,, ct.r. ,•�y,�,,2.-4 r �;�3 .a �.,.�'},,. r J ,t, .�.;;cl
A: .Y: .T•,:°i':.*s,. ,,jr, {�, 7 i;., s 1,:: :..tea.:-1 ,l '.i{ ,.,k.,, rt. ...a_!.;•f. - .. i.
T ) i? 1 F @Yr Y. p Viq� pp grf.ry .R k, �y d att ' at J Q•xf ri itnl9gt ,k''j l A
!.&�� �'�Lfk{41�'S
�r4'1
'/ � �{�{ Q nomn`` s/n✓�, ( l �� t'.,
LU
fry°ti';1
t Fr 2 ID
IN
4.
f �1
qu � �
N
GI
r n �
TNT
LO
C tL ./
4,
��f1(
tU
LO
}i{�t f r rx r � N � � Q y_ v'"�".�xlr�,%✓'��yx� �vl t��� ����
F
D O s�tl
N Z4
//r;, -, sa.. �:''��. 'a���;-. � .�.-� 7 '� �,�..x�t�j� - �n:f: .,1,,,>��l�°.��'j �.•+,a cox_}.j,• ��r�.}. s ., E .�,F..t �•.�.t,�?7 � �,.i7�_!3� � ;� t ��„
I d :2g Ja.r,(jL Cadiz• 'ts`�.f 2-K ��t 1�. r�t�ir '` ��}`s `*~S r r.L��e 1,, i” �y� i�r ���`�i 'E l � t'x7.� ,}1 } a � 11 ,�,,1,
1"14
Pill ili�l,illi"lllll,:Il,:Illillillillill111111110
IS'
Cutler-Hammer 60-AMP Weatherproof AC Pullouts
DPU222R-SOAmp Non-Fused Pullout.
BR241_60NAR mftAMp Non-Automatic Circuit Breaker.
Designed as disconnects for light duty air conditioning and heat pump applications.
We stock a wide range of Cutler-Hammer products.We stock products not available on this webpage.
Back To Main Order Quote Products Back'To Cutler-Hami-ner
ELECTRICAL
SUPPLIES
4'�
F 7 7 T M.
fittp:/1/\VWW,M U ri roe I ectri c.coin/catal og/cutl erham nier/a CP U1 10 Lit.11tall 5/25/2007
r✓ommonweaIg of 1i'/asjaclurselfs Official Use Only
Permit No.
K ¢�arinzenl a era erviead
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev, 1
(leave blank)
APPLICATION FOR PERMIT TO PERFORM. ELECTRICAL WORK
All work to be performed in accordance with the Nlassachusctts Electrical Codc(?V1EC),527 Clvit2 12.00
(PLEASE PIUNT IN INK OR TYPE-ALL 1NF0RVL1170N) Datc:
City or Town or: 19 0 Li 4 To ale lnsl)ector oj`!Y'rres:
By this application the undersigned gives notice ol•his or her intention to perform the electrical work described below.
Location (Street &Number) JA z r
Owner or Tenant �� a.�d �5�.�.-> F--kr•-izAV,�,titc�-cN Telephone No.
Owner's Address
Is this permit in conjunction'with a building.permit? Yes ❑ No ❑ (Check Appropriate Box)
1'urlWse of Building Utility Aulhorizntion No.
Existing Service Amps / Volts Overhead ❑ Undbrd ❑ No.of Meters'.
New Service Amps / Volts Overllcad ❑ Undgrd ❑ No. of ilIeters:
�C1
Date.....' ..........................
tq ruble may be waived br the his'ector of Wires.
No.of Total
NoRTM ITransformers ' KVA
TOWN OF NORTH ANDOVER t
�? •` °� Generators Kl A
PERMIT FOR WIRING 1 0. 01 Elliercrency.Lighting
*
Battery Units
' x FIRE ALARDIS 1'o.of Zones
cHUS �
i o.of Detection and
I Initiating Devices
This certifies that ................... ...' :..` wF��C......`r :: f..:•......... 'No. of Alerting Devices
t rf . ,l No. of Self-Contained
has permission to perform .....:.J s.' . < .. '..`....:...t......................I................ - Detection/Alerting Devices
Local Ihiunicipal
wiring in the building of........: ¢t` "} :°:!:':'.. :1 1 ......................... ❑ Connection F-1 Other
e° �� r /`?l Security Systems:
at....�.�(a....5,4,tu..?.�'�.!. f....$..:; ........ ; ,North Andover,Mass. No.of Devices or Equivalent
_ Daia'r','iriug:
Fee. /`�..°'":..... L1c.No. ....%:.? .� Z.t ...../� 't�c..`�f`�'6.. °...!lam No.of Devices or Equivalent
ELECTRICAL INSPECTOR 'I'eleconlnlutiications `N'11•Il1g:
r- No.of Devices or E uivalent
Check #
desired, or as rewired by the Inspector of Wires.
C `o armance of electrical work may issue unless
`'Fie 1licensee°pro vides°pcoot o?IiaVil fy uperaucin' coverage or its substantial equivalent. The
undersigned certifies that such coverage is iii force,and has exhibited proof orsame to the permit issuing office.
CHECK ONE: INSURANCE ey BOND ❑ OTHER ❑ (Specify:)
(Expiration Datc)
Estimated Value of Electrical Work:* (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance tivitll MEC Rule 10,and upon completion.
I certify, under the paints and penalties of perjury,uteri they hiforuradon on this applicativn is true and complete.
f IWNI NAME: Buddy Electric Inc LIC.NO.: 12017_A
Licensee: Vincent Bo Lamd ers JR Sibnatur L1C.itio.: 23684 E
(/f applicable, enter "erempt-in the license number line.) Bus.Tel.No.- —445
Address: 24 Colgate T)r � AndnvPr , Ma 01849 Alt.Tel.No.:
OWNER'S INSURANCE WAIVER: 12111 aWarc that the Licensee does not have the liability itsurance•coverage normally
required by law. By niy signature below,1 hereby waive this requirement. 1 am the(check:one) E] owner 1:1 owner's a,ent.
Owner/Agent PER:1fIT FEE: $
Signature 'Telephone No.