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Home My WebLink AboutHealth Permit # 5/18/2007 5 �Oplf" A Commonwealth of Massachusetts Map-Block-Lot 107,C-0027- - Board of Health PennitNo North Andover BHP-2007-0123 P.I. FEE � �scw xa F.I. — — $250.00 Disposal Works Construction Permit Permission is hereby granted William T. Sawyer to(Repair)an Individual Sewage Disposal System. at No 857 CHESTNUT STREET as shown on the application for Disposal Works Construction Permit No. BHP-2007-012 Dated May 18,2007 Issued On:May-18-2007 Board of Health tion for Septic ",Construction d TODAY'S DATE Permit OF RepairN " NORTH ANDOVER. MA 01845 cwu� a, $125.00 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 `[ 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 key. A. Facilit y Information rab Address or Lot# mow,- -- --- w. `" reNm " C ity/Tow --- " _ ` 2( 2.- *TYPE OF SEPTIC SYS 1 EW: i i11 Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Siodiffuser(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-Sox Present) S.A.S. 2. Owner Information SIM tf 1) r< a f " Name - -- - - o., Address�i s f different ffere��from bove�� .. -- --- -- - —r^�✓1 F"r_— —.— ��d_�,.� City/Town b State r Zip Code -- --- ----- --------- — ------ Telephone Number 3. Installer Information Name Na .�C'me of Company O's Address k &— - Address - — - City/Town - State - - Zip toy""3 Code Telephone Number(Cell Phone#if possible please) a. Desianer Information Name —-- Name of Company Address ------ - ----- City/Town Y State Zip Code r L C — --- Telephone Number(Best#to Reach) Application for Disposal System Construction Permit,Page 1 of 2 �a #r, n ,n Application for Septic I System 6 t)�',,..n BHA ------------ TODAY'S DATE - Construction rmit — TOWN • � �1 $ 250.�0p0� —.Full Repair $125.00 Comp,omp,nent PAGE 2 OF 2 A. Facility Information continued.... 5. Type of Buildin : Residential 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 th' 3oard of Health. Name Date d Health Re r "sentat Icatio A ro and o� p i e) pp y�(�o Name Day to J6 , r Application Disapproved for the following reasons: For Office Upp Only. � 1 Fee Attached? Yes No 2. Project Manager Obligation Farm Attached? �Yes No 3. Pump S 5y tem? If so.Attach copse of ElectricalPerznit Yes No 4. FoundationAs-Built?(new construction ronly): Yes No (Same scale as approvedplan) 5. Floor Plans?(new construction only): Yes No Application for Disposal System Construction Permit•Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: C" [0,3 C'NiZZ, For plans by ()ddiess of sepfic,sys,ton) < ,rm '�' 'W _'J e r Relative to the application of ( (h�St�Ac r's me) And dated (UrigmA date Dated 1 0" oday's date) With revisions dated (La,st w6sed 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 pfior 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 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'fide 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(1') inspection unless there is a retaining wall,which should be done first. The installer must request the inspection but does not have to be present. b. Final Construction Inspection pection—Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: torthandover.com) 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 (olber than siniple excavation)and I am required to complete the installation of the system identified in 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 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 121ans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer: (1'o S Date) t'(A 1)6�11) (Mimc " 1. maw"weaAk of MlaijacItueelfl EOcupangcy Cl16:11 Usc Only � 7 `' K JJe�ar�nrenf o�,}ira �arvicas k ` Fee Checked BOARD OF FIR E PREVENTION REGULATIONS ave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ail work to be performed in accordance with the Massachusetts Gicctrical Code(i1(CC),527 CNIR 13.00 (PLE.,ISE PRINT IN INK OR TYPE,,ILL iNFOR.V,1770t'i tiJ Da � �lc�� d City or 'I own of: /h �,u ')o ��2 To the lirspectorof bYtres: By this application the undersigned gives notice of liis or her iiiten(iou to perlorm the elccnicai work described below. Location (Street tee: Nwuber) `� h �.3 i n vT y T-- Owner or Tenant /1 ,cS T2 Telephone No. Owner's Address Is this perinit In con)ulictioli lvith n building permit? Yes ❑ No ❑ (Cliccl:Appropriate Box) Purpose of Building Utility Auihorizatiun No. Existing Service Anips / fails Overhead ❑ Undgrd ❑ Nu. of tINIcters . Ne•.v Service Anips / Volts Overhead ❑ Und-rd ❑ ' No. of!Meters.' Number of Feeders and Anipacity _ Locatig11 alai t`la,turc! of Prquoscd_Ele,ctr cnl Work: /,, 2 a t /t ie rabfe quail be waived by r/rc ins ector of I i1ires. T Total Date No. of ............................!... Transformers KVA f pORT1/ Generators KVA ° TOWN OF NORTH ANDOVER t o r Q ung atte Units PERMIT FOR WIRING i FIRE ALAPUNIS No. of Zoues No. of Detection and ��s'"" ' Initiating Devices SACMUS INo. of Alerting Devices This certifies that ....................... F�, ofSe11'-Contained .................................. Detectiotl/Alertino Devices - _w tlIunicipal has permission to perform ........, .. :.. .i........... .?..;t:. �.' .:` Local ❑ Connection Other a ! - Security Systems: wiring in the building of................. .t•t.r t 1�.F E...t ............................... No.of Devices or Equivalent r r Data Wiring: at.......... ....�. ....`.::: .:.t:,.. f,�;!lr.,t. ...... ....,North Andover,Mass. NO.of lleviccs or Equivalent 1'clecommunica(ions Wiring: Lic. �.... �..". �,:.. r :.. Fee . ., ...:, ... . No k " j:,•• No. of Devices or E uivalent ELLGTRICAL INS PECToR,/ A Check # gesired, or as required by the inspector of Wires. '3 r. •a prmance of electrical work may issue unless overa�,e or its substantial equivalent. The to (lie permit issuiri.office. CHECK ONE: INSURr1NCE BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cet•tif•, under the pains and peizahies of perjury,that they information on this application is trite and complete. FIRINI NAME: Buddy Electric Inc LIC.NO.: 12017:-.A Licensee: Vii.cen t B . I,a•nd ers JR Sianaturei LIC.NO. 23684 E (!f applicable, enter "cecrupt"in the license number tine.) Bus.Tel.No.: 9 75-4455 Address: 24 Col6atp 11r 1-i ArdnvPrr Ma t71fgdr, Alt,Tel.No.: OWNER'S INSU I::1NCE 1VAIVE12: I ant aware lliat the Licensee does not have the liability insurance coverage normally required by law. I3\• riiv si(,natw•e belo\v, 1 lierebv waive this requirement. I am the(check one) ❑ owner El 's agent. Owner/Agent Signature Telephune Nu. Pi�R:1fIT TEE: S