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Home My WebLink AboutHealth Permit # 8/14/2006 Commonwealth of Massachusetts Map-Block-Lot 104A- -79 - - -------------- Board of Health Permit No ® BHP -0245 North Andover -2 ---- --------------- P.I. FEE F.I. $250.00 Disposal Works Construction Permit Permission is hereby granted Todd-Bateson to(Repair)an Individual Sewage Disposal System. at No 514 WINTER STREET as shown on the application for Disposal Works Construction Permit No. BHP-2006-024 Dated August-14,2006 -------------------------------- ------- Issued On:Aug-14-2006 Board of Health ............................................................................................................................................................................... C r +i i7li'1 14 L I t I a T0 DAY S DATE .- 0 TOWN OF 20�►p.� Full Rppatr..,�) , $125.00 -Component ,qC HAl'..r Important: application is hereby made for a permit to: When filling out ❑I Construct a new on-site sewage disposal system* forms on the computer, use epair or replace an existing on-site sewage disposal system* only the tab key to move your ❑ Repair or replace an existing system component cursor-do not use the return key. A. Facility Informati®n r�8 - Address' - -- -- - -- - — roNm CitylTown 2.d *TYPE OF SEPTIC SYSTEM*: M ump ❑ Gravity (choose one) ***If pump system, attach copy of electrical permit to application*** ❑ Conventional System (pipe and stone system) m� Infiltrator or Biodiff user(Gravel-Less) (Attach a copy of your certification to install this type of system. ❑ Pressure Distribution S.A.S. (No D-Box) (attach Draft Maintenance agreement) ❑ Pressure Dosed (C-Box Present) S.A.S. 2. Owner Information 4,m r_(_t - Name j` Address(if differe t from above / , City/Town State Zip Code Telephone Number 3. Installer Information 9 Name Name of Company Address ------ - ----.__— --- - ----- ._.____ City/Town State Zip Code Telephone Number(Cell Phone#if possible please) a. Clesictner Information Name Name of Company Address Cit /Town 0�`� �_ State" � Zip Code r . Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 Z;o Z 0584.yivaaad uoiaonaasuoo waasAS lesodsi4 aol uoileoilddy ON SdA :(A'luo uoi$ona;suoo mou)z siivld ioolj 5 (i.,Pld pazoiddr sp oleos dmvS) ON �saA :(Aiuoi uo!;an isuoo mou)pyng-sy uor;npunol 't, ON saA lilluadlVOUloalj o oo givi V `os jj 2"d—lsltSillund T ON saA 2pagopiiV iucoj uoaan�algO,ia,�nupNliatoid .z ON —saA zpagvpV -,?1 't Iuo asn aoiuo Jo :suoseaa 6ulnn01101 aq;a01 panoiddesia uolleollddy p 94eQ � ,l^ uaeN -- _. --- —---- ---gip '� -- (aA!;e;uesaadey u;lead to preo !(g pan b eollddy eN .q)leapt#o paeoG s!u ;Rq �rs!uaaq seq aaue!ldcuoo jo o;eo!J!Uao a l!.;un uopeaado ut wa;sds ay; aaeld o;;ou pue `aa d'puV gPON to umo.L au;jol suope!nBed lesods►®ooepnsgnS leao-7 eq; se llem se `apoo le;uewuo nnu_g au;jo g of;!l jo suolslnosd au; qj!m eouepa000e u! cua;s�is lesodslp efiemas a;!s-uo poq!aasep-ejo;e au;jo aaueua;ulew pue uol;ona;suoa ay; ainsue o; seei6e pou6lsaapun eq.L uawagA ° leloaawwOO[] JO 6ulll@m(l lelluaplsa ppe Jo adAJL 5 °®°°penui}uo3 uoi4e mao#ul imoe.A ° aledoM Iln:j-oo'o9Z or JO Nj&0j ® I!WJOd uoijonilsuoow, ; 31Ha s,Avaol _ -- JeWaSla 314des Jol U01 INSTAI,T_ER PROJECT MAN A GEM I+NT OBLIGATIONS As the North Andover licensed installer for the construction of the septic system for the ... relative o the application property a l✓ ., m: � .. for plans by �,� and of d�° 1 l -..., dated dated ... f , with revisions date I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain t permits and approved plans approved he the slots to performing any work on a site, when any work is being done. 2, As the installer I must call for any dlwith myt company shomeowner, hedt le can inspection and he manger, or any other person not associated system is not ready then item three shall be applicable. 3, As the installer I am required to have the necessary at regcompleted eestin e an r inspect inspection, without inspections as indicated below. I understand that requesting g 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 Fled - 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. or en ineeremust befsubmittedcto inspection Boardtt ,of Health afternwhich installers calls b) Final inspection for verbal OK from g inspection time. Installer must be present for this inspection. With pump system all electrica. 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. y y orform the work (other than simple excavation) 4. As the installer I understand that onl n of the I may p required to complete the install t tnstallation. I further understand work by system othsrds uli ednsedt to install allseapplication s septic ms in North Andover can constitute r: asan reasons Town denial of North Andover; sgdnif cant fines U suspension of my license to operate persons involved are also possible. 1 must be on site during the performance nancs of the following 5. As the Installer l understand that 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 d instructions by the h omsowner,t installation generalcontrac.tcf rkl s or anyother per the approved plans. persons shall absolve me of this obligation. Undersigns 1 rased Septic Installer Date: - 17isposal Works Construction Permit# E CD \ / % § e Co / @ \ ® ° E \ @ £ I -t / \ 0 m \ 2 E * cc _ ® 5 \ @ 3 \ ± ' \ \ o \ E 2 ° / k { 2 co \ n 7° » ■ � � — e � ° W m 2zz: k / e A ' / S & § } \ \ E k / \ \ k $ 3 = 0 0 u CL % $ . Co 0 C)- I § - ^ � / / \ § $ % .� 'oo \ ƒ / / J .% _% % ° ) \ ®K# \ / \ / / ] / bate.. ....1.. .... ... .9...... poRVy - d 4, TOWN PERMIT FOR WIRING iL This certifies ..r .�6:4�t..:... �.�.......... ....m....{ ..�...................... has permission to perform ... ` ..... /:........................... wiring in the building of.. : : .... .. .......................................... at �& ...... ..1./✓..e 7... �...... 9 9 ...................... forth Andove► Mass. �............ Lic.lido. ................................. ................... ELECTRICAL INSPECTOR Check # Official Use Only Permit No.-J.. . ?+ F. �l1iG�iit±i�l?!/Fs14.� d�'!X✓�S (�I,SS�'7.5 a .f,;pl"Ste+ Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ail work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in Ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number 5/ Owner or Tenant t Z.1" t, k-0-1 Owner's Address 5 x No Check Appropriate Ba)o dity Authorization No. &. Undgmd ❑ No.of Meters Date Undgmd ❑ No.of Meters f-NOR7F, °� TOWN OF NORTH ANDOVER Z.p � . ' PERMIT FOR WIRING . � „ * Total o,,ro�,• No.of Transformers KVA CMUS�� Generators KVA No.certifies that ..,!r („l✓ �j "p°�j Bat of Emergency Lighting This .�J It ° � � ; Battery Units FIRE ALARMS No.of Zone has permission to perform -t' ?,� 1/�r/fh/� jr .z.-c No.of Detection and ......................................... Initiating Devices wiring in the building of...;.,/.�' rf ,S' """� /� .. ... .. ..l......................................... No.of Sounding Devices at....... ......�,3" 1 �.F �. - North No./of self Contained ort Andover, .............. . ,Mass. DetecdoniSounding Devices Fee.s;� ...... Lic.No. -'� ` ?.. ❑ Municipal ❑ Other .. ..... Local Connection ELECTRICAL INSPECTOR Low Voltage ' �eck 1/ � � Wiring 6t 6 INSURANCE COVERAGE. Pursuant to the requiremenfits of Aassachusetts General Laws I have a current Liability Insurance Policy indudingX,,ornplated Operations Coverage or its substantial equival 6��aqe�y NO have checked YES please indicate the checking the appropriate box NSURANC - OND = OTHER = (Please Specify) U Expiration Date) s mated Value of Electrical Work: 8 L 2 Work to Start Z -L� �, Inspection Date Resquestt d Rough Final Signed undert a Pe altleg of perjury: FIRM NAME cf C v:N- S . � LIC.NO. '' L LIC.NO. 1-13-7 3 Llkensee r1- G`-xi Signature Bus.Tel No. Address'. av Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the L enses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No PERMITfEE $ (Signature of Owner or Agent)