HomeMy WebLinkAboutHealth Permit # 6/9/2011 w°� w Map-Block-Lot
Commonwealth of Massachusetts
'44'�csL 104.A0083
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1
BOARD OF HEALTH Permit No
' North Andover BHP-2011-0718
9 S _____ _______ ________
9•�&:,. �.,...g s�, FEE
S�AS��se $125.00
DISPOSAL WORKS CONSTRUCTION PERMIT
Permission is hereby granted Neil J. Bateson
to(Repair-PIPE REPAIR)an Individual Sewage Disposal System.
at No 475 WINTER STREET
as shown on the application for Disposal Works Construction Permit No. BHP-2011-071 Dated June 09,2011
------------------------ ------------------------------
Issued On: Jun-09-2011 F TH °
---- --------- ------------------------- - ------------ a
;pT tt�M li ti r ti I /i
°cam m TOpAY'S DATE
ntrut�twn er It
250.00®Full Repair
"�*p•.. $125.00-Component
eku'
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 ® Repair or replace an existing on-site sewage disposal system*
only the tab key
to move your Ellepair or replace an existing system component—What?
cursor-do not
use the return
key. A. Facility Information
rd Address or Lot# �7..
�1 City/Town
r
2.-*TYPE OF SEUI�C SYSTEM*: � i,o IV a���
❑Pump ® ravity(choose one) �.� � "c
***if pump system, attach copy of electrical permit to application***
❑ Conventional System(pipe and stone system)
®Infiltrator or Blodiffuser(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
liz
Name
Address(if different from above
f
City/Town j
State
Zip Cade
Telephone Number
3. Installer Information
Name Name of Comp an
/ fix 1(14 ON ENTERPRISES,INC.
Address
/11,9 - ' VERMA01510
City/Town State Zip Code
917(y "/5- 1_ `7e) .I
Telephone Number(Cell Phone#lipassible please)
4. Designer Information
Name Name of Company
Address
City/Town State Zip Code
Telephone Number(Best#to Reach)
Application for Disposal system Construction permit•page 1 of 2
IN. Application for Septic Dispos I y stem p
tru tI Permit ®
TODAY'S DATE
Construction
.„ 4 $250.00--Full Repair
°g4.�aP��� , $125.00 -Component
� sAC14USEK
PAGE F
A. Facility.Information continued....
5. Type of Building: [ 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 y his Board of Health.
Name date
Application Approved By: (Board of Health Representative)
Name
Date
Application disapproved for the following reasons
For Office Use Only:
I Fee Atiached.a Yes No
Z. Project Manager Obligation Fotm Attached? Yes No
3. Pump&stein? If so.Attach copy of Electrical Petrnit Yes No
4. Foundation As-Built?(new construction ronly): Yes No
(Same scale as apptovedplan)
3: Floor Plans?(new construction only): Yes No
Application for Disposal system Construction Permit•Page 2 of 2
'
DelleChiaUe 'Pamela
From: Sawyer, Susan
Sent: Tuesday, May 31 20114:03 PM
To: UgUeCh|e|e, Pamela
Cc: Grant, Michele
Subject: 475 Winter
FYI �
Neil will be submitting a Title V for 475 Winter St. recommending a cl-box repair due to corrosion of the concrete. This is �
one of Two D-boxes and is not necessary to the systems function. It was likely left there after a repair in 1988.
D'boxxviU be removed and replaced with pipe only. |told Neil it was his choice whether to have a dean'outor not. It is
not required 10 have one.
He may ormay not be the installer, but whomever does it,this is what they need to do.
Susan
�."�
���aa Sawyz*
Yub&Kim"DVW±"
100V0,3aoodStud �
XNg 2V,umit 2~36
Nndh amdowx4/fa 01845
uffme 978 688~054V
978 688-8476 |
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1
SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction for the septic system for the property at:
(Address of septic system) For plans by
' /
Relative to the application of �e IV At S,A-1 And dated
(Installer's name)
gtna -ate
Dated --3 //
o ay s ate With revisions dated
ast 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 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 manager, or any
other.person not associated with my company schedules an inspection and the system is not ready, then
item hree 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 (V)inspection unless-.there is a retaining wall,which
should be done:first. The installer must request the in 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: healthdeptna townofnorthandover co m) 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 farther
understand that work done by others unlicensed-to install septic systems in North Andover can constitute
reasons for denial of the system and/orrevocation 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 thatI m ust'be on-site during the performance of the following construction
steps:
a. Determination that the proper elevation of the excavation has been reached.
h. Inspection of the sand and stone to be used.
c. Finalinspection hyBoard ofHealth 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 resi2onsible for the installation of the system as per the
approved glans. No instructions by the homeowner general contractor, or any other persons shall absolve
me of this obli anon.
Undersigned Licensed Septic Installer: �' (Today's Date)
(Name—Print) igne