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HomeMy WebLinkAboutHealth Permit # 11/17/2014 Commonwealth of Massachusetts Map-Block-Lot • �� r;c°�,y�' 104.80073 BOARD OF HEALTH Permit No North Andover BHP-2014-1289 PA. FEE F.I. $125.00 DISPOSAL CONSTRUCTION I T Permission is hereby granted Todd-Bateson to(Repair)an Individual Sewage Disposal System. at No 162 HAY MEADOW ROAD �" ----------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2014128_ Dated, November 17,_2014 Issued On:Nov-17-2014 BOARD OF HEALTH TODAY°S DATE — TOWN Construction Permit 250.00—pull Repair NORTH ANDOVER3 MA $125.00-Component Important; A—pplication is hereby made fcrr a penmit to: When filling out ❑ construct a new on-site sewage disposal system" forms on the computer,use epair or replace an existing on-site sewage disposal system only the tab key 04epair or replace an existing system component—What? `' r��f to move your cursor-do not use the return A. Facility Information key. G� /�%�r � �, �� „ ✓ -- • Address or Lot# 6ity/Town 2.-*TYPE OF SEPTIC SYSTEM*: ➢ ❑ Pump ravity(choose one) C ***If pump sy em, attach copy of electrical permit to appbc tron*** a y� °r i '�ta, ,,'" ➢ Conventional System (pipe and stone system `�`,�,x�r"w� � vvl ❑ Infiltrator or Biodiffuseri(Gravel-Less)(Attach ch f"yd' rcertification to install this type of system.) ➢ ❑ Pressure Distribution S.A.S.(No D-Box) ➢ ❑ Pressure Dosed(D-Box Present)S.A.S. > ❑ Does the system require an effluent filter? Yes No If yes, does plan specify make and model of filter? YES=(no further info. needed) NO=(installer must specify brand of filter before®WC issuance) What is the Make? What is the Mode[ 2. Owner Information Name Address(if different from above) ,,d�ryry ��pp y �y'I.rnd,.N sa V-4—/ _ /V/y Cityfrown State Zip Code Telephone Number 3. Installer Information Namey � Name of Company Address li AN u W L City/Town State Zip Code Telephone Number(Cell Phone#if possible please) 4. ®esielner Informmation Name --- Name of Company - Address Citylrown State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 �OR7N Applicatfon..for Septic Disposal :System 3 c TODAY'S DATE 4V p Construction Permit -TOWN. OF , -ORTH ANDOVVER MA 01845 $.250.00--Full Repair �,S „•�' :� $125.00-Component SACHO PAGE 2OF2 A. Fadifity.Information continued.... 5. Type-of Building: LIKesidential Dwelling or[]Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-slte sewage disposal system In accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been Issuedpy this Board of Health. Name Date Application pproved BZ�he rd of Health Representative) ;�Ic� Da te'on Disap oved fo following reasons:` For Office Use Only: 1 Fee Attached.: Yes �/ —. No 2. PtojectManaget Obligation Form Atiaehed? Yes I No 3.: Pump–&ste ? rTso,Attach CQpv ofElecttrca,__P it' Y.es_ No 4. Foundation As Built.?(new construction-ronly)r No (Same scale as approved plan) tr A Floor Plans?(new construction only). .Yes_ No Application fior•pisppsal Systeiii:Gonstruction Permit,Page 2 of 2 Aa d*Ngrth Andovts'licx=cddijft fir tH tauatatcd4lt f then ae;ptsc eyetetsa ar.the�prcrp pyat: (Ad4iiir ofs pdc symm) For pious by (iaats es'e ate) Abd dated Dued u a � With rtvi of dated (Z=r,/rmstd date) I uudmtand the following obtigatiom for raanagcmcut o$this project: i. As the installer,I axzs.obligated�6btdmaallpe=its andBoxrd ofHealth approved plans• to prxfosmiog«np:work cia a Iite, f mu$t ltayeta�vedt# . As flit is tnlier;.I,Privat•411. Or any and 211ttapudom I£hoxnec-=*',cantmctQ4 ptoject ger,or any otbtrpamon not 04ock.ted with m7 campaay:�ebe Cf' an inOV eW at,Ind the gatcsn is not read ,theft stem thxee•drilht,applicable. 3. As•tom iFtst Z' to.have t6 iu b. Saws- Aetr.�� y work r tkd•g�fot to theopplWble eC6otts as �s u � is �A'` ' apeatoa gala.there is a-rctaiomg,�,a ,rich ahtaYc bt drniIie:` i,tall�ratiat flit�itiajreest but ages u©t have Ga b . .b. ''' —� tccr�ti�t�t.dn• oprescriwt•, Aa+`b t of at OK'(Or tesbpaa for oTivt►tia •tom,etc. r e-rma tq. from then erf to -be ttibbdIttrd tai Via,Boudd'vf Fi'e a erttvhi�:Pi` for aii must be teamt far ,inapecd �ifspecti�a time. 'Iost�lior iriust .trio►orlc�iud;ata:m'tofui P kcal�arcnu�t be tea snd able to c. zntrae tequet utap�ctson tvhei X11! adg is ctwsplttc: Installer does not I>AVes tp ira bn"adte. 4. As'tbeinsWlrts'I=a jft�thatonly I pperfa rhg. rock' otbtrtlirmr timjr�a on) �cord ete tlie•nat lath a of tier { t �ad;I atri teggired pl gstc�idea far#fit:.utt e�I applt`�atfOA for itism'ltatson> 2u�nsfor daaival�f tlit trr '�dlh` c��ott et atiioii ?#rnit ° n .ti `„ A1 Notch Andover.xilptificaint 1floa3o an "cm b2 boeaifi 5.. At tha.i stsdller,=t tatiderjt��dm I m t�t•on',4tA And4 dzt±•pexf�imia�re of tfit ioIloa►itag constrnctit�n sus; , .. �: 1)ster �tla�eft fie,prrsper elev�rfo�a earft&e r�rrc�t�ab'aua 1��•ber.;o rettrhea� . - A ins p�i�'a�oithe send and stdd e to be trm c. 'Firrafaspevrr#�yBvcxf.Ythert ''orc�sult d. hwtsadh t Ofmt*}3-. axf pY 4e srtoAt, arrt�P_ rWp. bet .reftw Wgffsad atl`ter . 6. mufM bb fion, in tf Undea�nird Ilcaaaed Senc. sta ter, N - - -- flpd2V'