HomeMy WebLinkAboutHealth Permit # 10/2/2001 Town of North Andover, Massachusetts Form No.3
BOARD OF HEALTHc
of ao°T
OL
O F
F
0 DISPOSAL WORKS CONSTRUCTION PERMIT
,SSACHUSBS
Applicant OA, TELEPHONE
NAME ADDRESS
Site Location
/ - -
Permission is hereby granted to Construct ( ) or Repair an Individu I Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
CHAIRMAN, BOARD OF HEALTH
Fee 4-� D.W.C. No. !r
BOARD OF HEALTH
NORTH ANDOVER, A 01845
978-68$-9540
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: 11 �°, �C�1 CURRENT INSTALLER'S LICENSE#
LOCATION: C. /C' . .4
LICENSED INSTA ER: a w,C.
SIGNATURE: TELEPHONE#
CHECK ONE: dr
REPAIR: NEW CONSTRUCTION:
IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
$160.00 Fee Attached? Yes No
Foundation As-Built? Yes No
Floor Plans? Yes No
Approval ' . 'r Date: �" )
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the
property at A l fikq relative to the application
of v (0 N)64 ed 1 .° '—O( _for plans by— r � t Q and
dated ^C.J with revisions dated ( "
I understand the following obligations for management of this project:
I. As the installer I am obligated to call for any and all inspections. If homeowner, contractor,
project manger, or any other person not associated with my company schedules an inspection
and the system is not ready then item two shall be applicable.
2. 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 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 not have to be present.
b) Final inspection — Engineer must first do their inspection for elevations, ties, etc. As-built or
verbal OIL from engineer must be submitted to Board of Health, after which installer calls for
inspection time. Installer mast be present for this inspection. With 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. Does not have to be
on site.
3. As the installer I understand that persons or companies not associated with my company may
not perform the work required by my company 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 in the Town of North Andover plus
significant fines to all persons involved.
4. 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.
d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other
components.
5. 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.
UnTLicensed Septic Installer
'�Ao� ", Date:
Disp sal Works Co tiuction/Prmit#