The URL can be used to link to this page

Home My WebLink AboutHealth Permit # 10/27/2006 ORY� Commonwealth of Massachusetts Map-Block-Lot i a 98A- -8 0 � Board of Health ---- ---- -"-"- " Permit No 0 9 o North Andover BHP-2006-0721 ° $ P.1. FEE �ssACkU'-4 F.I. $250.00 Disposal Works Construction Permit Permission is hereby granted John Soucy -------------------------------------------- ------- -------- -------------- ------------ to(Repair)an Individual Sewage Disposal System. at No 114 REA STREET -------------- ------------------------- -------------------- -------------------------------------------- as shown on the application for Disposal Works Construction Permit No. BHP-2006-072 Dated October 27,2006 ---------------------------- Issued On: Oct-27-2006 ------ -- - --- - - """"- " --"" ------------------------- -------------------------- --------------------------- Board of Health rod _ �l f r TODAY'S DATEr,,. �morarr� < n tru tion Permit " ORTH $ 250.00—Full Repairs,"/'/ �Srocwu �� ANDO VER. $125.00 - Component Important: Application is hereby made for a permit to: When filling out ❑ C,onstruct a new on-site sewage disposal system* forms on the computer, use 6/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# — ------- - --------- - ---- -- -- ----------------- --- - rennn City/Town 2.- *TYPE OF SEPTIC SYSTEM*: DPump ❑ 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 Closed (D-Box Present) S.A.S. 2. Owner Information n _37 Name — - -- --- -- Address(if different from above City/Town__ State ---- ---- Zip p e Telephone Number 3. Installer Information Name Name of Coml5any Address - - r 1 City/Tow 1411 City/Town G� State f �°° Zip Code Tl ephone Numbef Cell Phone#if possible phase) 4. Designer Information r `YP Name Name a Compariy� Address -.._. --- -° -- e . ''- -- :.- Code 11 City/Town err , State Zip I phone N ber(Best#to Reach) - Application for Disposal System Construction Permit<Page 1 of 2 lip ion r tl I y t tko T y o S1 Kt en r ° TODAY'S DA E - Construction ermit - TOWN OF $ 250.00-Full Repair .," $125.00 - Component PAGE 2 OF 2 A. Facility Information continued.,,. 5. Type of uilding: 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 issy 'd by this Board of Health. Nwne Date -- - Application Approved y: (Board of Health Representative) - - -------------------------- — Name Date Application Disapproved for the following reasons: For Office Use Only: Z Fee Attached? Yes No Z. Project Manager Ohligation Form Attached.? Yes No , 3. Pump System? If so,Attach cQpE of Electfical Permit Yes � No 4. Foundation As-Built.?(new construction ronly): Yes No (Sine scale as approved plan) / 5. Floor Plans? new construction only): Ye No ( y): 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: (Address of se stzc system) For lays b Relative to theapplication a Irinec;.) o£ � �� `£ Onsialler.'s name} And dated t;w Y 11'lna date) Dated I t — 7 e) With revisions dated t 0 s (Last re6sexd 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 nior to performing any work on a site. I must have the apl2roved 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 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 (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-Engineer must first do their inspection for elevations, ties, etc. As-built of verbal OK (or e-mail to: hc.aaltlacic:f rc vnc>,;Et7c 1°t iando� 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 tban.ripple eticamlion)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 . 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 a1212roved plans No instructions by the homeowner, general contractor, or an other ther persons shall absolve me of this obligation. Undersigned Licensed Septic Installer:er: ,� �I = , � Today's )ate) ° r �„, o. . .,..� o ate„.a^ �' �� ; � ,�✓ e ;�s„„ artie._. Print) tip "—w ec. Department of Fire Services PemutNo. 7 e 2- -7 b Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod VEC),527 CNIR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) D a t e:�® �C 2 U 04 cJ C City oi-Town of: � . � To the Inspector of Wires: By this application the undersigned gives notice ol his or her intention to perform the electrical work described below. Location (Street S Number) Owner or Tenant Telephone No. Owner's Address �iS�YIL Is this permit in conju tion with a building permit? Yes ❑ No [:�� (Check Appropriate Box) Purpose of Building , /*ti/c. Utility Authorization No. Existing Service ?Z Amps Volts Overhead [� Undgrd ❑ No.of Meters f New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: -7—/ 44 T Completion of the following table may be waived by the Inspector of Wires. No.of Total Transformers KVA Generators KVA Date ` o.o +mergency ig i g ............... Battery Units f HOW7H FIRE ALARMS No of Zones 3r°,�t ``-°t•;�"�o� TOWN OF NORTH ANDOVER No. If Detection ti tints Devi -es A PERMIT FOR WIRING No.of Alerting vices No.of Self-Co ained � NUS Detection/Ale ing Devices SAC Local❑ M icipal ❑ Other nn C ection _ Security stems:* This certifies that .. ,••.•,62,;'(J/,d� No.qX Devices or Equivalent perform r' r�l rlr Data firing: has permission to rform ......�.C' .............. .... .... ...................................... N .of Devices or Equivalent wiring in the building of.,, /..!?1,..,�'%t .....?,}„;, Tele ommunications Wiring: .� •••••••••••••••••••••••••••••••••.......... No.of Devices or E uivalent at........a.`P.....t��.l': .....: �. ........................... .North Andover,Mass. f tEC esired,or as required by the Inspector of Wires. Fee.. ............ Lic. No.6�.3SI ?..................� ., / �, ' palpolicy.) ELECTRICAL INSPE R Check t1 Rule 10,and upon completion. onnance of electrical work may issue unless 7027 overage or its substantial equivalent. The to the permit issuing office- CHECK ONE: INSURANCE L-T BOND [J UlritK LJ kbpecuy.l I certify, corder the pad is tu rd penalties of perjury,that the information out this application is true and complete. FIRM NAME: a LIC.NO.: � _ Licensee: , 1-7) CJ'i t�C�.. Signature LIC.NO.: (If applicable, enter "exempt”in he license number litre.) Bus.Tel.No. Address: GJ Alt.Tel.No.: *Security System Contractor License required for this work; if apps cable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑ owner's ag t. Owner/Agent PERMIT FEE: Signature Telephone No. i Date� .... ....®. .. 4 NORTH o TOWN OF NORTH ANDOVER ` WIRING R PEMIT FOR �SSACMUS This certifies that ..�•� ••••••� .. / �-.....P.. . has permission to perform ....:�.��. J.'.'.'.?�.................................. wiring in the building of.'7- ••••• �' North Andover,Mass• .,J......... Lic.No. Fee.. � ELECTRICAL INSPECTOR Check # I 7027