The URL can be used to link to this page

Home My WebLink AboutHealth Permit # 9/11/2007 f 4'®RTW ; Commonwealth of Massachusetts Map-Block-Lot o o 107.D-0081 - ®d Board of Health ® � Permit No ® North Andover BHP-2007-0265 - ----------------------- P.I. FEE `y 4 ,3SACtrUS F.I. $250.00 Disposal Works Construction Permit Permission is hereby granted James Kellett to(Repair)an Individual Sewage Disposal System. at No 534 BOSTON STREET as shown on the application for Disposal Works Construction Permit No. BHP-2007-026 Dated September 11,2007 -------------------------------------------------------------- Issued On: Sep-11-2007 Board of Health e 7 Applica ion for 0 f. TODAY' Construction Permit - TOWN OF ORTH ANDOVE C N 6 $125.00 -Component Important: Application is hereby made for a permit to: When filling out ❑forms on the EJ Construpt,16"new on-site sewage disposal system* computer, use air 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. Facility Information A) ------------------- rob Address or Lot# City/Town 2.- YPE 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. ressure Distribution S.A.S. (No D-Box) (Attach Draft Maintenance Agreement) F-I Pressure Dosed (D-Box Present) S.A.S. 2. Owner Information 4`! Name7 _6571�"L_dO Address(if different from above) City/Town State Zip Code Telephone Number 3. Installer Information Name Name of Company _14 Address State Zip Code 7 V Telephone Number(Cell Phone#if possible please) 4. Designer Information Name Name of Company Address City/Town State Zip Code Telephone Number(Best#to Reach) Application for Disposal System Construction Permit-Page I of 2 °RTw Application for S o 2 �to TODAY'S DATE Construction i ® TOWN ORTH $ 250.00- Full Repair $125.00 -Component SgACHU PAGE 2 OF 2 A. Facility Information continued.... 5. Type of wilding: 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. fi Name Date Application Approved By: (Board of Health Representative) Name Date Application Disapproved for the following reasons: oe a� X./r For office Use only: � el Fee Attached. Yes °"" No 2.,1/Project Manager Obligation Form Attached. Yes " No 3 Pump System? If so,Attach copy ofElectrYcal Permit Yes No t ' 4. Foundation As-Built?(new construction ronly): Yes No (Same scale as approued'plan) 5. Floor Plans?(new construction only): Yes `� 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: Oclelre. K,l septic lA�0{ C .B"/ 4 .. , ( l y ull) For plans by Relative to the application�lic.ation of ar rrtc And dated ),0 � raka„inn Tate) Dated <m d oa:ay s date) With revisions dated ” 011 ist 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 r� for 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 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 retaining wall,which should be done fast. 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 OIL (or e-mail to: liealtlmcie)t ii?towiiofnortl-,,aaiclover.cc>tn) 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.maple excamlion)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, 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 ine of this obligation. Undersigned Licensed Septic Installer: '° �// 7 ((;1`oday's Date) w/ acne rent) r7'Ie - . 1{„,—IC C j Sep 12 07 06: 55a Jim Kellett 751 -595-3330 p< 1 ATT: Pam ' I James Kellett give Patty Meehan permission to pick up permit for 534 Boston st. Thank You, am.es Kel ett Commonwealth Of Massachusetts Official Use Only Department of Fire Services Permit No. -y Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9°/07 d o City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pe form the electrical work described below. Location(Street&Number) �j�� j IJ 2C Owner or Tenant e 7 Yid Telephone No. Owner's Address SAMe Is this permit in conjunction with)a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: (J f r?,c vCa G �G1 t'�f i ��/a S tx✓� . Ic-� table may be waived b the Inspector o Wires. No.of Total r� Transformers KVA Date.......,r..`.` .::. .•/ Generators �'A No.of mergency Lighting Batter Units ; Of NORTH 1 TOWN OF NORTH ANDOVER FIRE ALARMS No.of Zones PERMIT FOR WIRING No.of Detection and Initiating Devices No.of Alerting Devices CH�E� o.of Self-Contained Detection/Alerting Devices z Municipal Local[] Connection E] Other This certifies that ................ ..............................0................................... "7 Security Systems: has permission to perform ........ f 'e. ��/ ��'� No.of Devices or Equivalent ..... ........................ ............................... . • • Data Wiring. i No.of Devices or E uivalent wiring in the building of........l.. ....... :. .................................. Telecommunications Wirm . �..... g G / ,�"w` No.of Devices or E uivalent at........�...:....j....::�`5...�...':`................................... .N rth Andover,Mass �-T- fi? -Z � '' !esired,or as required by the Inspector of Wires. Fee..................... Lic.No. ............. ......................... . ...... ....... .. ELECICAL INSPECTOR ipal policy.) L IEC Rule 10 and upon completion. Check # >rmance of electrical work may issue unless ?verage or its substantial equivalent. The to the permit issuing office.I certify,under thepatlis anJd pen lttes of perjury,that the information on this application is true and complete. FIRM NAME: Ig1/tCT �' G )- LIC.NO.: ��fP Licensee: Sg(oc Signatur ,,y Zrt1 _ LIC.NO.: (Ifopplicable,enter "ex cm ""min the licel+�e�number It ) Bus.Tel.No.: T°� " 'p�� Address: fild �21V 11 iV0 �QA/ Alt.Tel.No.:Q 2F-S,,::2- -7raO *Per M.G.L c. 47,s.57-61,security work requires Departkient 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 a ent, Owner/Agent PERMIT FEE: $ Signature Telephone No.