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HomeMy WebLinkAboutHealth Permit # 5/22/2013 i i i i I i Map-Block-Lot Commonwealth of Massachusetts a . ----- ----- � �� � � ' BOARD OF HEALTH permit No BHP-2013-0724 North Andover --------------------- FEE $250.00 --------------------- F.I. — DISPOSAL WORKS CONSTRUCTION PERMIT Permission is hereby granted William Sawyer-------------------------------------------- to(Construct)an Individual Sewage Disposal System. at No -2005- - --SALEM- STREET ----- --- -------- -- --------------------------- ---- - - - ------------------------ - - --------- as shown on the application for Disposal Works Construction Permit No. BHP-2013-072_- Dated­May-22-,-20_13 __May 22,_2013 --------------------------------- --------------- ------------ BOARD OF HEALTH Issued On:May-22-2013 --------------- "M 05FE" A l ation f�r tip i o i f�� � fCJ17AY,f,l7Aif. onstruction Permit —TOWN OF f $250.40—Full Repair �� ORTH ANDOVER 01845 $125.00-Component Important i is hereby made for aW permit to: Anulicatiar when fiflurc/our Construct a new on-site sewage disposal system* forms on the computer,use [] only the lab key Repair or replace an existing on-site sewage disposal system* to move your [I Repair or replace an existing system component—what? cursor-do riot use the return key. A. Facilit y Information Address or Lot# - - City/1"own 2,-*TYPE OF SEPTIC SYSTEM*: ❑Pump Gravity(choose one) ***If pump.`ystem,attach copy of electrical permit to application*** ❑Conventional System(pipe and stone system) ❑Infiltrator or Biodiffuser(Gravel-Less)(Attach a copy of your certification to Install this type of system, F1 Pressure Distribution S.A.S.(No D-Sax)(Attach Draft Maintenance Agreement) El Pressure Dosed(©•Box Present)S.A.S, 2. Owner Information Name Address(if different from above) Cily!f own Slate Zip Code I clephone Number 3. Installer Information [ Gr Pj l Name " ✓ Name of Company Address CilytiownR�� rva / r�J�_ /�``� F6 t✓,��pe"? Slate Zip code IolophoneNumber(Cc//Phone#if possible please) 4. Desi ner Information Name e / Name of Company Acidrass , City/town Slate Zip Code Telephone Nnrnlrer(Best#to Reach) Application for Disposal System Construction Permit-Palle 1 of 2 qAF �F, wa�m li�aki�n fc�r tip i coal � rr� � -Construction Permit — TOWN F' rOf7AVSt7ArL �� $250.00--Full Repair UFtT�I ANDOVER $125.00-Component PAGE 2OF2 A. Facility information continued.... 5. 'Type of Building: [ '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 s _ 4 Y s oard of Wealth. been issued by thi Name Date Application Approved By:(Board of Health Representative) Name Date Application Disapproved for the following reasons: For Office Use Only: 1. Fee Attached? Yes Na 2, ProjectrYlarraffiaer ObligationForni Attached? Yes No A Purnp Systerrr? Ifso,Attaclr copy ofEleen cal Perrin Yes No 4. Foiiiid ltior2 As-Birilt?(neW eo l,�titiction roriPy): Yes No (Same scale as approvedphq) 5. Floor Finns?(new construction only): Yes No Application for rlleposal Sysfem COnf ItnCt1011 Pormit-Pago 2 of 2 SI?TTIC',SYSTU-'M INSTALLER PItOJI C:'I:'MANAC=I?MI N`I'Olil,I(aA'I'IONS As the`worth Andover licensed installer for the construction for the septic system for the property at: 2 ,6 C ldVi,a , yr1Aa twtrrutk� For plans by '')e/'xr I ml6 w'.,. c� Relative to the ap,9licarsun of � xr„y,ovx�` r uVoCtr. err u ) And dated �?A, yl�� Dated ..._ ._ � � _W_......w... ._.._._w R'iClr revisions dated (B Ise rtr°x^rr^d dmr) I understand the following obligations for management of this project: 1. As the installer,'�I am obligated to obtain all pennits and Board of l lealth approved plans prioi to performitng any work on a site. T mast have the approved plans and the permit on site when any work is being done. 3. As the iastaller,I must call for any and all inspections. If horneowner,contractor,project manager,or any: other person not associated with my company schedules an inspection and the system is not ready,their 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 belo,,v. I understand that requesting an inspection,without completion of the items it accordance itlt_Title_.5.„and the_T3o,tic#_off Ictilth Itctritl:tcians rnx}_rc salt_ur..a”](7.(70 ititc.Using levied t f;inst,me and/or my company. a. Bottom of Bed—Generally,this is the first(1 a inspection wiless there is a retaining Rrall,which should be clone fist. The installer must request the inspection but does not have to be present. b Final Construction Insvection Eut;inccr nntst first do tlreit ittspectiorl f'or elevations,ties,etc. As-built of verbal_OK(or e-mail to;9n_c�Btlaul i�b.f,¢atitar��erwas;;,;gtascprt,l'q..'ta�s,j«ar,.p r;,d�at;a) from the engineer must be submitted to the Board of Health,after which installer calls for an inspection time. Installer trust 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 tecluest inspection-when all grading is complete. Installer does not have to be on-site. 4. As the installer,I vaiderstand that only I may perform the work(olber Mini sij)6ble e."ravali n)itird I ani required to complete then installation of the system identified in the attached application for .1-furthell Understand that work done by others unlicensed to install septic systems in North Andover cats constitute reasons for denial of the system and/or revocation or suspension of my license to operate iu the To-wri of North Andover,significant fines to all persons involved are also possible. i. As tine iastaller,I tuxdetstand that I must be on site dining the petfornrarrce of tyre following coustrtnction 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 tang, D-.Box,pipes, stone, vent,pump chamber, retaining wall and other components. G. As the installer,I understand that I am solely responsible for the installation of the system as per the al ... , X ihome. > , cc>nt cc,te5 of .c 7y other ocrwn shall absolve 51ats etiSttuetaYS I, the rt icrl<nci tl . me of this obliggion. Undersigned Licensed Septic Installer: (""i:real ly's 1:1rute) Z.V h ;sadtrc �a rcao) °l I�l ) _ � n:i;anat