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HomeMy WebLinkAboutHealth Permit # 3/27/2003 Town of North Andover, Massachusetts Form N0.3 e yORTH BOARD OF HEALTH �SSACHUSEt� DISPOSAL WORKS CONSTRUCTION PERMIT Applicant . r �� NAME ADDRESS TELEPHONE Site Location �7 Permission is hereby granted to Construct ( ) or Repair (Y--an" Individual-Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. CHAIRMAN, BOARD OF HEALTH Fee 7 D.W.C. No. APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: CURRENT INSTALLER'S LICENSE# LOCATION: LICENSED INSTALLER: SIGNATURE: TELEPHONE# CHECK ONE: REPAIR: NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $175.00 Fee Attached? Yes No X, Foundation As-built? Yes No Floor plans on file? Yes No Approval Datef,_..,L/ INSTALLER PROJECT MANAGE, +NT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the property at ; � (,c t � relative to the application of .., _dated ­I for plans by n,.. ...�: and dated with revisions dated 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 prior 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 manger, 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 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 OK from engineer must be submitted to Board of Health, after which installer calls for 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. 4. As the installer I understand that only I may perform the work (other than simple excavation) required 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 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 plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer � Date: Disposal Works Construction Permit# Town of North Andover ©� �'ORTFI a 4`4RV . Office of the wealth Departrnent y.. Community Development and Services Division � ;Y 27 Charles Street °Ah YEU PPP`.jJ North Aj ldaver,Massachusetts 01845 �SSRC�au�E� Heidi Griffin Telephone(978) 688-9540 Acthig Public Health Director Fax(978)688-9542 TOWN OF NORTH ANDOVER BOARD OF HEALTH CERTIFICATE OF COMPLIANCE DATE OF COMPLIANCE February 9,2004 This is to certify that the individual subsurface disposal system constructed ( ) repaired (X) by Mike Reilly at 206 Forest Street North Andover, MA 01845 as been installed in accordance with the provisions of Title V of the State Sanitary Code and with the North Andover Board of Health regulations. The Issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. Sis Y.Sawyer,R.S. Public Health Director BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535