The URL can be used to link to this page

Home My WebLink AboutHealth Permit # 9/2/2008 Map-Block-Lot �a��, Commonwealth of Massachusetts 107.A-0143- ve <, aa ----------- Board of Health Permit No BHP-2008-0177 _ North Andover -------- ° FEE P.I. f {: $250.00 aca��fi F.I. ---------------------- Disposal Works Construction Permit Permission is hereby granted James-Kellett _----___-_-_---_-_--_-_-_------_------------------ to(Repair)an Individual Sewage Disposal System. at No 69 OAKES DRIVE ---- ---- - --------- - -------- -------- - ------- ------- - as shown on the application for Disposal Works Construction Permit No. BHP-2008-017 Dated___August 28,2008----- ----- --------- --------- - - Issued On: Sep-02-2008 Board of Health N ',TM Appliqp ion for Septic Disposal System OF Y4o iygti ° AConstruction Permit — TOWN OF TODAY'S DATE �9 ORTH ANDOVER MA 01845 `$25000— Fun Repair CNU9 ' Component Important: Application is hereby made for a permit to: When filling out ❑ C n'struct a new on-site sewage disposal system* forms on the computer, use 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 �^, E, I ( hr,-rs a ne Address or Lot# } Cityrrown 2,. TYPE OF SEPTIC SYSTEM*: Pump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) ❑ Infiltrator or Biodiff user(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 Dosed (D-Box Present) S.A.S. 2. Owner Information Name Address(if different from above) City/Town State Zip Code Telephone Number 3. Installer Information Name Name of Company dress qq I—A � pn City own State Zip Code Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address } �/ ell City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page 1 of 2 ,JRTN li ins r tic i 0 -" 4° °X TODAY'S DATE tructi Permit - TOWN OF i 01 1 $ 250.00® Full Repair $125.00 Component PAGE 2 OF 2 $ACNUS�' A. Facility Information continued.... 5. Type of B,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 S of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North ndover, and not to place the system in operation until a Certificate of Compliance has been i sued by this Board of Health. r N Date Appli tjb�n Approved B IBoard of Health Representative) F' Npoe Date Application bis'approved for the following reasons: For Office Use Only: Z Fee Attached? Yes a� No 2. Project Manager ObEgatron Form Attached? Yes - No 3. Pump S y s tem.a If so,Attach copy of Electrical Permit Yes No 4. Foundation As-Built,?(new construction rortly); Yes A46 (Same scale as approyedplan) 5. Floor Plans?(new construction only); es Na Application for Disposal System Construction Permit•Page 2 of 2 SEPTIC SYSTEM INSTALLER PROJECT MANAGEMENT OBLIGATIONS As the North Andover licensed installer for the construction for the septic system for the property at: of septic ( 1 \ " r (Address ste an For plans b5� k Relative to the application of 4 ` t - �( ��c�N, Q (`l,n°,t llcr's name) And dated rrlxs.na r ate. � Dated ��c ay s dale) With revisions dated w 2 0 ,,Y (l; _,...,ast revised 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 rp�ior to perfornung any work on a site. I must have the apt2tz �oved plans and the pertnit 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 retaitvng 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 OITi (or e-mail to: 1�c4�iw�lt �pl��tc��llr.�ta7e�ttl�at�dr>�re®s,wcc�r.rt) 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 than sijvple excavation 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 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. Deter tnination 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 oftanlf,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. fo Undersigned Licensed Septic Installer: , -°� `� day!'s Date) amc —I�rtnt: atI'le--"Sign e(1) �o -17 � °OW a NORTH N CB ' Sly <i n��fq PERMIT N ' WI 1N ....,., 'f'N'►is certifies that has permission to tsc;d, t ,...,., v�✓irirtg in the cif cNrr)g cst �" ., .........., f� North P rlsvar,Mass. at . . .. ..., .. . .......... r; v V � Commonwealth Of Massachusetts Official Use Only Department Of Fire Services Permit No. Y3 �-o Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEQ,5277 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: S 1 City or Town of: NORTH ANDOVER To the Inspec or of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 62 QA-k'F,5 Vg i k Owner or Tenant (21 k R $ 140 a.N/ Telephone No. Owner's Address SA Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building ^F 'j i Ax)¢ Utility Authorization No. a � Existing Service 0 Amps 2 0 /940 olts Overhead® Undgrd❑ No.of Meters hnn °-- New SP.•v:r.• Overhead Undgrd ❑ No.of Meters ' 7 oaANt><' -6 AOOAPI, 'l IAICgl'06�f Official Use Only l tN Q , ( / !achusetts3 Permit No, Services oz� letion o the ollowin table m be waived b the Inspector o Wires. y Occupancy and Fee Checked �_ idle Fans o.o Total � � Transformers KVA Generators KVA s r o.ol Emergency Lighting Battery Units Date. FIRE ALARMS No.of Zones ! .. o.of Detection and. NeRrM Initiating Devices TOWN OF NORTH ANDOVER ' No.of Alerting Devices p o.of Self-Containe « r PERMIT FOR WIRING Detection/Aierting Devices «��9 Municipal .> + Local❑ Connection Other Ss�cHUSw, Security Systems:* No.of Devices or Equivalent Data Wiring: No.of Devices or E uivalent is ertifies that a ecommunrcattons w gyring: f No.of Devices or E uivalent has permission to perform, wiring in the building desired,or as required b the Inspector o Wires. 9 y n f /i ..............I.......•..... cipal policy.) at............... {a r ••••••••••••••••.. . .... ,North Andover,Mass. C Rule 10,and upon completion. °,,1� Fee � � • Lic.Nor.!sz'.r: ormance of electrical work may issue unless .. �' verage or its substantial equivalent. The ELECTRICAL INS, _s a to the permit issuing office. Check /i Lpfication is true and complete t t { LIC.NO.:a6 ers — r �tJ LIC•NO.: No.of Detection and Bus.Tel.No.• d Address: U Ev2 t do Cd 6 19 Alt.Tel.No.: - /9'*Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. 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 agent. Owner/Agent PERMIT FEE: $ d Signature Telephone No. IC