HomeMy WebLinkAboutHealth Permit # 4/6/2004 Commonwealth of Massachusetts M4p_Stack_>At
Board Of Health 907.C-0005
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North Andover PecmitNo
BHP-2004-0347
F.I. _ FEE
-----------------------250.00
Disposal r Construction Permit
Permission is hereby granted John Souc
to(Repair)an Individual Sewage Disposal System.
at No --9-8-4-YpWq AT REET
as shown on the application for Disposal Works Construction Permit No B-HP 2004-034 ,
�d . pril 06,2004
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Issued On:Apr-06-2004
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APPLICA'T'ION FOR DISPOSAL WORKS CONSTRUCTION PERMIT
DATE: °�( .�._. f� '`()1 j CURRENT INS'TALLER'S
LOCATION:
LICENSED INS I'A ,EI2: ' G�,, Q,
SIGNA TURE:- _ ` � TELEPHONE G
f # _ t
CHECK ONE:
REPAIR: i z NEW CONSTRUCTION:
IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT.
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Administrative Use Only
$ 00 Fee Attached?
Foundation As-built? Yes No
Floor plans on file?,"' Yes
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Approval _ _ ....._ Date: °
INSTALLER PROJECT MANAG>r ANT OBLIGATIONS
As the North.Andover licensed installer for the construction of the septic system for the
property at c � ! �'�"°'e" 0 -9- , relative to the application
of&/,l- "--6�t' dated �f— -�'t( for plans by /, 6!� any
dated with revisions dated 3—t
I understand the following obligations for management of this project:
1. As the installer I am obligated to call for any and all inspections. If homeowner, contra(
project manger, or any other person not associated with my company schedules an inspec
and the system is not ready then item two shall be applicable.
2. As the installer I am required to have,the necessary work completed prior to the applic;
inspections as indicated below. I understand that requesting an inspection,_ witt
completion of the items in accordance with Tile 5 and the Board of Health Regulations i
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 d
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
verbal OK from engineer must be submitted to Board of Health, after which installer calls
inspection time. Installer must be present for this inspection. With pump system all electr
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
on site.
3. As the installer I understand that persons or companies not associated with my company rr.
not perform the work required by my company to complete the installation of the cyst(
identified in the attached application for installation. I further understand that work by oth(
unlicensed to install septic systems in North Andover can constitute reasons for denial of t
system, and/or revocation or suspension of my license in the Town of North Andover pl
significant fines to all persons involved.
4. As the Installer I understand that I must be on site during the performance of the followi:
construction steps:
er elevation of the excavation has been reached.
a) Determination that the prop
b) Inspection of the sand and stone to be used.
c) Final inspection by Board of Health staff.
d) Installation of tank; D-box, pipes, stone, vent, pump chamber, retaining wall and oth
components.
5. As the installer I understand that I am solely responsible for the installation of the system ;
per the approved plans. No instructions by the homeowner, general contractor, or any oth,
persons shall absolve me of this obligation_
Undersign ed Licensed Sept' Installer
Date:
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Disp 'al Works Construction P t#