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Home My WebLink AboutHealth Permit # 5/8/2012 Map-Block-Lot Commonwealth of Massachusetts -----------------------107.D0005 BOARD OF HEALTH Permit No BHP-2012-0575 North Andover ----------------------- --- --------------- FEE P.I. $250.00 ------ F.I. DISPOSAL WORKS CONSTRUCTION IT Bill Hall Inc. ------- Permission is hereby granted _ ___ _ _ _____----------------- -- ---------------------------------------------------------- to(Construct)an Individual Sewage Disposal System. at No 305 BOSTON STREET_-- -_ __ _ __ _ _ -- ---- - - - -------- as shown on the application for Disposal Works Construction Permit No. BHP 2012057 . Dated May 08,2012 ---- ------------------------------------ BOARD OF HEALTH Issued On:May-08-2012 e - a `o " a o q January 24 2012 - -- --- - - o i " f C7t AY.'S LtA TEu.,.,_. o Construction I" m IOWN OF� � R MA 01845 12 ...0. ..0 m -Caen)e one t Q Important: Anplicafloqjs herel made far permit_9c When filling out ❑ Construct 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 ke A. Facility Information �� ❑ v� 305 Boston Street(Assessors Map 107D, Lot 5) r' Address or Lot#/ „ l North Andover ..— -- -- `f' t l�tr��t.... st��,rLtt ran city/Tow n pt W"pu°#UV7tttV ro�ilw�m�;tnu�i�uwm ��ewwwiu� A .- *TYPE F SEPTIC SYSTEM*: El FIN (choose one) ** �r c° " a. 1❑Q❑� ; ***If pump system, attach copy of electrical permit to application ❑ � / , � ❑ Conventional System (pipe and stone system) �N� ❑ Infiltrator or Biodiff user(Gravel-Less) (Attach a copy of your certification to install this typ of system. ❑ Pressure Distribution S.A.S. (No D-Boas) (Attach Draft Maintenance Agreement) I ❑ Pressure Dosed (D-Box Present) S.A.S. ❑ 2. Darner Information Robert Houghton Name 44 Ash Street Address(if different from above) North Andover MA 01845 City/Town State Zip Code Telephone Number -- — -- 3. Installer Information . (� ��.c' � . a' b�� 1 ------- — - -- -- -- N e Name of Company -- - - ---- -- -- -- Address " City/Town State Zip Code Telephone Number(Cell Phone 11 if possible please) 4. Cesic�nr Information Philip Christiansen Christiansen & Sergi, Inc, Name Name of Company 160 Summer Street Address Haverhill MA 01830 --- ----- ---- — - -- --- — --- -- - City/Town State Zip Code 978-373-0310 ------------------------------------ ------ -- Telephone Number(Best#to Reach) Application for Disposal System Construction Permit•Page 1 of 2 �4 �n r a �° January , 201 ,. ,...® 0 TODAY'S DATE Construction i r i — TO"' OF ' ' 250.00 Full Repair,r•u•r €�4 — $125.0(1 component " ^YCF-0U"��' PAGE 2 OF 2 A. i1e 1r� �a° or� c�rr6r� •o 5. I1/ e of Bt ilding: ❑Residential Dwelling or[]Commercial B. Agreement The undersigned agrees to ensure the construction and maintenance of the afore-described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code, as well as the Local Subsurface Disposal Regulations for the Town of North Andover, and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Name Date Application Ap 6ved By: (Bo ),d of health Representative) p Name , Date Application Disapprov"' for thef6llowing reasons; For Office Use nl - L Fec Attaclied? Yes °-- 2. ProjectMairager Obligatioii For in Attaclied? I'e� "'' ` No r` .3. gwp_,$,�teiii? Ifso,Attach c v of�IectrrcalPetiiiit Yes �o ' 4. Fouiidatioii A, -Built?(near construction ronl y): Yes No ud (✓aiiie scale as,prrouecl pla ) 7 ' 5. FloorPlrris?(new construction only): Yeas No 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: �. to�T-e��3 -s.i" (Address of se pti � .c y,tein) For plans by (Engineer) Relative to the application of :C'CEnLtalle'4,A name)(_ � OIL ,�^ And dated } � � 7 1� 3 rigimi, a'e; Dated o qty s date) With revisions dated (L,oxst revised(late) 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 121ans 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 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(V inspection unless there is a retaining 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 OK (or e-mail to: hC11t11d t t t��"t:ow:ic fn��rtl�x:ii7c#:��er.corn) 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 (otbcr than simple 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. 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, 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: 1 � I�_,'To ml's Date) 7arne-- Print) (Nai Fie- 4 ignec)