HomeMy WebLinkAboutHealth Permit # 10/30/2003 Commonwealth of Massachusetts Map-Block-Lot
104.A-0017-
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Board Of Health Pemit No
North Andover -BHP-2003--0346----
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P.I. FEE
F.I. $250.00
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Disposal Works Construction Permit
Permission is hereby granted John_So4cY---------------------------------------------------------------------------------------------
to(Repair)an Individual Sewage Disposal System.
atNo -32 HOLLOW-TREE LANE------------------------------------------------------------------------------------------------------------
as shown on the application for Disposal Works Construction Permit No.-BHP-2003-034__ Dated October-29,2003
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Issued On:Oct-30-2003 Board Of Health
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`4
APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: ff)--d 70 CURRENT INSTALLER'S LICENSE,#__
LOCATION:
24
LICENSED INSTAT
SIGNATURE:
CY
TI PHONE#
CHECK ONE:
REPAIR: C NEW CONSTRUCTION:
IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
Administrative Use Only
Fee Attached? Yes No--
Foundatiou As-built? Yes No
Floor plans on file? Yes No
Approval Date:
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North.Andover licensed installer for the construction of the septic system for the
6 F
property at
r�L _p relative to the application
� �;� �—,,
of dated for plans by and
dated with revisions dated
I understand the following obligations for management of this project:
1. As the installer I am obligated to call for any and all inspections. If homeowner, contracto
project manger, or any other person not associated with my company schedules an inspectio
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 applicabl
inspections as indicated below. I understand that requesting an inspection,. withou
completion of the items in accordance with Tile 5 and the Board of Health Regulations ma.
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 dons
first. Installefnnust 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 oi
verbal OK from engineer must be submitted to Board of Health, after which installer calls foi
inspection time. Installer must 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:
vation of the excavation has been reached.
a) Determination that the proper ele
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.
Undersi ed icensed Septic Installer
Date: t' :_— -
Dispos orks Con ction Pe #
I